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Biomedical subjects

J Baltzer

Publications and source records attributed to J Baltzer.

At least 19 recordsLinked to original sources
PubMed1992

Results of surgical treatment of 1028 cervical cancers studied with volumetry.

BACKGROUND AND METHODS: The clinical staging system of cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) entails a large measure of subjectivity. This study analyzed the results of 1028 patients with cervical cancer at three reference centers. All patients had radical surgery, and all surgical specimens were processed as histologic giant sections with precise volumetry of the tumor. RESULTS: The interpretation of the histologic findings of parametrial invasion, vascular involvement, and lymph node involvement was found to differ somewhat among the three centers. However, all these findings were associated with tumor size. Survival rates correlated more consistently with tumor volume than with clinical or histologic stage. Five-year survival rates ranged from 91% for patients with tumors smaller than 2.5 cm3 to 70% for those with tumors 10-50 cm3. The 5-year survival rate of 24 patients with tumors larger than 50 cm3 (71% of whom had lymph nodes with positive findings) was 48%. Survival rates were identical among the three centers for patients with tumors smaller than 10 cm3, despite different degrees of surgical radicality. In contrast, more radical surgery was associated with significantly better survival rates in patients with larger tumors. CONCLUSIONS: The results of this study indicate that volumetry of the tumor permits a more accurate assessment of therapeutic results in patients with cervical cancer than does the FIGO classification. Pretherapeutic assessment of tumor volume is possible with magnetic resonance imaging. It seems that maximum parametrial resection is not necessary for patients with smaller tumors (smaller than 10 cm3), but truly radical surgery in patients with bulky tumors achieves better results than those usually expected in Stage IIb cervical cancer and at least comparable to those of radiation therapy.

Adult↗
PubMed1990

Carcinoma of the cervix and pregnancy.

A simultaneous occurrence of carcinoma of the cervix and pregnancy is uncommon. In a cooperative study a total of 1092 patients treated for cervical cancer were examined. Forty of these women were either pregnant at the time of surgery or were operated on postpartum. The course of the disease for these patients was compared to that of 426 non-pregnant women with cervical cancer. The analysis of tumor grading and tumor growth revealed no remarkable differences. Remarkable, however, was the increased frequency of blood vessel invasion observed in pregnant patients, particularly in puerperal patients. Also the percentage of macrometastases was higher in puerperal and/or postpartum patients. These findings might explain the worse prognosis for these women.

Adult↗
PubMed1989

[Precancerous conditions and early stages of vulvar cancer].

Precancerous lesions and early stages of vulvar cancer are being increasingly observed in young women. Diagnosis is possible by means of clinical examination, colposcopy, cytology, and specific biopsy. From a prognostic and therapeutic point of view it is important to differentiate between preneoplastic and early invasive squamous cell carcinoma and to remove the lesion completely. In the case of patients with vulvar stage A carcinoma, an organ-conserving surgical procedure is justified, since a metastatic invasion of the regional lymph nodes would seem unlikely. In the case of patients with carcinoma beyond this definition an individualized tumor treatment is undertaken taking account of defined morphological prognostic criteria.

Adult↗
PubMed1989

Primary squamous cell carcinoma of the neovagina.

Primary carcinomas arising in the neovagina are rare and this is the ninth reported case. Two adenocarcinomas and seven squamous cell carcinomas, including our own case, have been described. The type of carcinoma is related to the transplanted tissue. Although the optimal therapy is unclear, we would recommend surgical treatment rather than radiation therapy. This is based on our own experience and on observations reported in the literature. Regular follow-up of patients with an artificial vagina is mandatory.

Adult↗
PubMed1989

[Pregnancies in females following kidney and pancreas transplantation].

Uraemic patients are in general infertile. Ovarian function is, however, restored after successful renal transplantation, thus making conception possible. We followed up 14 patients after renal transplantation involving 16 pregnancies. Two patients became pregnant twice, one with twins and the other following renal and pancreatic transplantation--the first recorded in the world. Caesarean section was performed in all patients due to increasing serum creatinin levels, avoid pre-eclampsia or premature rupture of membranes. Both, mother and child in all cases progressed without complications, although these pregnancies are associated with high risk for both. Therefore, a close co-operation between the mother, the nephrologist, the transplantation centre, the gynaecologist and the paediatrician is a prerequisite for a possible favourable course.

Abnormalities, Drug-Induced↗
PubMed1989

[Clostridium infection in the puerperium following cesarean section].

Clostridium perfringens infections in the puerperal period are rare. A 22-year old patient, after caesarean section at another hospital, was admitted to our clinic showing clinical signs of haemolysis, slight uraemia, a crepitation of tissue and sonographical signs of air bubble formation in the uterus. Since clostridium perfringens infections show a high mortality rate, early operative measures under high-dose Penicillin treatment are indicated. In this case, hysterectomy and salpingectomy were performed. Both ovaries were unaffected and could be conserved. In addition, a peritoneal lavage was done. Our patient was discharged as cured after a postoperative course without any complications. There is no evidence in the literature for the efficacy of either antitoxin treatment or a high oxygen therapy.

Adult↗
PubMed1989

Pregnancy after combined pancreas-kidney transplantation.

Four successful cases of pregnancy after combined pancreas-kidney transplantation at four different centers are summarized. The techniques used for the pancreas transplantations were duct obstruction in one patient and enteric exocrine diversion in two patients; in all three patients the insulin delivery was to the systemic circulation. In one patient exocrine diversion was to the stomach and the vascular anastomosis to the splenic vessels, thus accomplishing portal insulin delivery. Immunosuppression consisted of cyclosporin and prednisolone in two patients; cyclosporin alone in one patient; and cyclosporin, azathioprine, and prednisolone in one patient. In all a cesarean section was performed, due to deteriorating renal function in two patients, a fall in fetal growth in one patient, and fear of inducing pancreas-graft pancreatitis during normal delivery in one patient. In all four women, perfect metabolic control was retained throughout the pregnancy, and despite the proximity of the pancreas graft to the growing uterus in three of the women, the pancreas grafts did not suffer any damage during the pregnancy. However, in one patient the pancreas graft was lost in acute rejection after delivery. This pancreas had functioned normally for 3 yr before this occasion. Of the offspring, one was completely normal, one had a bilateral cataract, and two were small for date. The latter two subsequently showed normal growth development. At follow-up at 3, 5, 7, and 28 mo, all kidney grafts and three of the pancreas grafts remained functional. We conclude that after combined pancreas-kidney transplantation, successful conception and pregnancy can be obtained. Despite reduced islet mass (segmental grafts), normal metabolic control can be retained throughout the pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Precancerous conditions and cancer of the endometrium].

In recent years the incidence in endometrial cancer is rising. The relation of cervical to endometrial cancer has shifted to almost 1:1. The peak of age distribution is between 50 and 60 years of age. Accompanying diseases are obesity, diabetes and hypertension. The endometrial cancer has its precancerous stages. The pertinent estrogenic stimulus is probably significant for the development of precancerous lesions: adenomatous hyperplasia of the endometrium without atypias is known as an optional, that with atypia as an obligatory precancerous lesion. The range of morphologic variation extends from mature endometrial adenocarcinoma with favorable prognosis to immature neoplasias with unfavorable outcome. Besides various other parameters of neoplastic disease the depths of infiltration into the myometrium is known to be significant. The leading sign of endometrial cancer is uterine bleeding. The histological diagnosis is established by the examination of the tissue produced by curettage from the cervical canal and from the uterine cavity. A true early diagnosis--in comparison to the early detection of cervical cancer--does still not exist for endometrial cancer. Exfoliative cytology from the uterine cavity or ultrasonography does still not allow the final and definite diagnosis. Among the therapeutic alternatives abdominal hysterectomy in combination with bilateral adnexectomy plays the most important role. Depending from more specific morphologic criteria of a given case additional pelvic and paraaortic lymphnode-dissection is advised. Surgical therapy in general accounts for a 10 to 20 percent better survival. In patients who cannot surgically be treated because of the local extension of the tumor or due to a general high risk situation the primary therapy is pelvic irradiation both by packing and percutaneously. Disseminated neoplasms, adenocarcinomas in particular, respond well to large dosages of progestins, whereas combinations of cytostatics have failed to show favorable results, perhaps with the exception of those containing adriamycin. All endometrial cancer patients need special posttreatment care, because early recurrences still have a certain chance of survival when recognized and appropriately treated.

Endometrial Hyperplasia↗
PubMed1988

Comparative morphometric study on the depth of invasion in vulvar carcinoma.

Various studies assess the significance of depth of invasion as an important prognostic factor in squamous cell carcinoma of the vulva. However, methodologic problems exist with regard to the measurement points. While the deepest point of invasion can be measured accurately, the upper reference point is arbitrarily chosen. The goal of the present study was to identify the method of measurement and the threshold value, allowing the clearest prognostic differentiation between groups of patients with vulvar carcinoma. The study involved 124 patients treated between 1971 and 1980, who had received identical treatment (simple vulvectomy followed by local and inguinal irradiation) and identical histopathologic workup (large-scale sections). Beginning with the deepest point of tumor invasion, comparative measurement was carried out with three different points of reference: to the basement of the most superficial dermal papilla (method A), to the surface of the tumor (method B), and to the basement membrane of the deepest rete ridge (method C). The data were used to determine differences in specified end points. The results and conclusions are as follows: (1) The morphometrically determined degree of tumor invasion had prognostic significance. (2) Measurement of tumor thickness (method B) prognostically differentiates patient groups better than measurement of invasion from the most superficially lying epithelial papilla (method A), if classified into tumors up to and over 0.5 cm. (3) Patients with superficial invasive vulvar carcinomas up to 0.5 cm can be further prognostically differentiated into two groups, when measuring depth of invasion from the deepest rete ridge (method C), and classifying into tumors up to and over 0.3 cm.

Adult↗
PubMed1988

Adjuvant radiotherapy in patients undergoing surgical treatment for carcinoma of the cervix.

An analysis was made of the results from operations carried out on 1092 patients with cervical cancer during a co-operative study involving four universities. Standardized surgical procedures and histological processing of the surgical specimens were employed throughout. The indication for post-operative irradiation therapy was different in the University Departments. In order to carry out a realistic comparison of the results obtained, tumour extension, histologically determined on the surgical specimen, was used as a criterion, clinical staging not being used. In cases presenting a continuous tumour growth corresponding to histological Stage Ib, the five-year survival rates achieved were 90.5% and 95.6%, respectively, for patients who had received surgical treatment only and those who had had postoperative irradiation therapy. In cases of continuous tumour growth amounting to histological Stage II, the corresponding five-year survival rates were 79.5% and 83.1%. The difference between the survival rates of patients who had had or who had not had postoperative irradiation was not statistically significant. The further proof of tumour parameters in the formation of twin pairs revealed that the prognosis of patients presenting unfavourable tumour characteristics could not be influenced by postoperative irradiation therapy.

Carcinoma↗
PubMed1987

[Value of palpation and mammography in primary breast cancer. A retrospective study 1973-1982].

The value of palpation findings and mammography in 596 patients with primary breast cancer was investigated. The most frequent symptom (86.1%) was the lump. The primary tentative diagnosis came from the patient in 63.4% of the cases, from the physician in 28.9% of the cases, and only after mammography in 7.7% of the cases. False-negative palpation findings and false-negative mammography findings were observed in 9.9% and 5.0% of cases respectively. There was a clear dependence on the tumor stage. Carcinomas that were first diagnosed by means of mammography manifested a five-year survival rate of 82.6% and a recurrence rate of 15.2%. Carcinomas that were first discovered by the patient or the physician reached a five-year survival rate of 67.7% and 70.6% respectively. Here, too, the recurrence rate was higher, at 26.2% and 22.1% respectively. The data show that the carcinomas that were first suspected mammographically were smaller and manifested lymph node metastases more rarely. In order to reduce the number of false-negative findings the physician performing a mammography or assessing X-ray films should himself submit the breast in question to a thorough palpatory examination.

Adult↗