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Biomedical subjects

J Haas

Publications and source records attributed to J Haas.

At least 217 records · Page 12Linked to original sources
PubMed1988

Magnetic resonance imaging in clinical cervical cancer: pretherapeutic tumour volumetry.

MRI can define the spread, size, and volume of clinical cervical cancers. Appropriate pulse sequences and slice thicknesses are necessary. Twenty-five patients underwent MRI tumour volumetry before radical hysterectomy. The volume obtained by MRI was compared with that obtained from the histological giant sections; the volumes agreed at a statistically significant correlation coefficient of 0.983. The volumes obtained by MRI of 13 unfixed surgical specimens correlated with their histological volumes with a statistically significant coefficient of 0.894. Tumour volumes were compared with the respective clinical stages. Clinical stage did not correlate with tumour volume. Three very large tumours were in clinical Stage Ib. Tumour size is a major prognostic factor, can be measured easily, and, as the basis for classification, is superior to FIGO staging. MRI can measure tumour volume before treatment.

Female↗
PubMed1988

Prognostic factors in cervical cancer on the basis of morphometric evaluation.

As for all tumours, the most important prognostic factors in cervical cancer are growth pattern and the extent of its spread. The systematic study of serial giant sections of specimens obtained at radical hysterectomy has made these morphological factors assessable by biometry. Statistical analysis produced the following ranking of prognostic factors in cervical cancer: the size of the primary tumour, lymph node involvement, infiltration of the connective tissue layer between cervix and parametrium, exophytic growth, parametrial invasion, and mitotic rate. These factors can be used in a biomathematical model to exclude or predict tumour recurrence or death from disease.

Female↗
PubMed1988

Prognostic factors in cervical carcinoma: a multivariate approach.

The primary aim of this study was the identification of factors known at the time of primary treatment and contributing to the risk of developing recurrent cancerous lesions. This chapter presents a multivariate approach to the identification of prognostic factors in cervical cancer. Using logistic regression analysis, a correct prediction rate of approximately 80% was reached for recurrence or death of disease. The number of lymph nodes involved, border zone and parametrial involvement, exophytic tumour growth and mitotic activity were identified as prognostic factors.

Carcinoma↗
PubMed1988

Pelvic and para-aortic lymphadenectomy in cervical cancer.

The surgical treatment of invasive cervical cancer must both remove the primary tumour and eliminate the paths by which it spreads--i.e., the lymphatics and the lymph nodes. In 359 patients, systematic pelvic lymphadenectomy yielded positive nodes in 30.3% of Stage Ib and in 44.7% of Stage IIb cases. In the 140 patients with positive nodes, the obturator group was involved in 76.4%, the external iliac group in 62.8%, and the presacral and subaortic nodes in only 4.3%. One node group was involved in 55% of the patients, two and three groups in 27.8% and 7.1% respectively. In patients with only one positive node group, the obturator nodes were involved the most often (31.4%), followed by the external iliac (21.4%) and parametrial nodes (9.2%). Nine patients with Stage Ib and 31 patients with Stage IIb disease underwent para-aortic as well as pelvic lymphadenectomy. Positive para-aortic nodes were found in 11.1% and 22.6%, respectively; 12.5% of these patients had major complications, but there was no surgical mortality. Since radiotherapy cannot sterilize positive nodes, systematic pelvic and para-aortic lymphadenectomy may improve the survival of such patients.

Aorta↗
PubMed1988

The significance of the parametrium in the operative treatment of cervical cancer.

The first sharp improvement in the operative treatment of cervical cancer was the shifting of the plane of resection away from the tumour into the parametria. This permitted resection of the primary cancer with a margin of healthy tissue. Systematic studies of excised parametrial tissue, carried out around the turn of the century, showed four types of parametrial involvement: continuous, discontinuous, carcinomatosis of the parametrial lymphatics, and parametrial lymph node involvement. It is well known that histologically demonstrated parametrial involvement often contradicts the clinical stage. So-called staging laparotomies are meant to address this problem but they, too, are inadequate since most parametrial cancer deposits are microscopic and cannot be palpated. In our own studies of totally extirpated parametria, contiguous cancer spread into the parametria never exceeded 10 mm, not even in the largest still-operable tumours. Thus the theory of contiguous, direct cancer spread to the pelvic wall is wrong. Parametrial involvement usually occurred as cancer deposits in the rarely mentioned parametrial lymph nodes. Parametrial involvement correlates better with the size of the primary tumour, expressed as the tumour-cervix quotient, than with the clinical stage. The smallest tumours, without showing continuous parametrial involvement, had a 3.4% incidence of positive nodes. Thirty-five per cent of the patients with the largest tumours had positive parametrial nodes. Parametrial lymph nodes were found in 280 (78%) of 359 surgical specimens processed as giant sections. Sixty-three patients (22.5%) had positive parametrial nodes. The nodes at the pelvic wall were involved in 80% of the patients with positive parametrial nodes. The five-year survival rate was 84% if the parametria were free of disease, but it dropped to 53% with any type of parametrial involvement. Survival rates did not differ much if only the parametrial nodes or only the pelvic nodes were positive (56% and 66%, respectively). However, if both groups were positive survival dropped to 43.1%. Positive parametrial nodes can be located anywhere in the parametrium; therefore, surgery must remove the entire structure. It remains to be seen whether an exception can be made for small Stage Ib tumours, or if lymphadenectomy can be omitted in these patients. If so, radical vaginal surgery may be the treatment of choice.

Female↗
PubMed1988

Objective results of the operative treatment of cervical cancer.

Surgical staging of cervical cancer samples the retroperitoneal lymph nodes and, at some centres, the parametria. While better than subjective clinical staging, its value is limited because the results of a sampling procedure differ widely from those of a systematic lymphadenectomy. Additionally, considering the pathology of parametrial involvement, it seems unlikely that biopsy can find the majority of parametrial cancer deposits. The most precise data on the spread of cervical cancer are produced by radical hysterectomy and systematic lymhadenectomy. The tumour size has proven to be the most important prognostic criterion and therefore the best suited for patient classification. Tumour size can be measured by a number of methods. Between 1971 and 1987, 583 of 867 patients with Stage Ib to IIb cervical cancer underwent surgical treatment. Lymphadenectomy was systematic and hysterectomy included the resection of the entire parametria at the pelvic wall. In a total of 359 serial giant sections were of sufficient quality for evaluation; most were Stage IIb cases. The frequency of positive pelvic lymph nodes was 30.3% among 132 Stage Ib cases and 44.7% among Stage IIb cases. Most tumours occupied over 40% of the cervical volume. Five-year survival by clinical stage failed to show a statistically significant difference between Stages Ib and IIb. Objective classification by tumour size showed the patients with the smallest tumours to have a five-year survival rate of 92.1%. The patients with the largest still-operable tumours occupying 80% to 100% or more of the cervix still had a five-year survival rate of 65%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Adjuvant chemotherapy after radical hysterectomy for cervical cancer.

Invasive cervical cancer can be treated by surgery, radiotherapy, and cytostatic chemotherapy. For decades, surgery alone or in combination with radiotherapy was the treatment of choice. At our hospital, primary radiotherapy was reserved for patients with advanced disease. Antineoplastic agents, especially combinations which included cisplatin, achieved good results in patients with advanced disease--or after other therapeutic modalities had been exhausted. This led us to use postoperative chemotherapy for high-risk patients with positive pelvic or parametrial nodes or vascular invasion. Radiotherapy had not improved the survival of such patients. A combination of bleomycin, vincristine, mitomycin C and cisplatin was used. The results were compared with those of patients who had received radical abdominal surgery only (n = 166) or surgery and postoperative radiotherapy (n = 170). The 29 patients who underwent surgery and chemotherapy had a statistically higher incidence of all risk factors. Nonetheless, after a three-year follow-up they had fewer recurrences and fewer deaths than did the other patients. We believe that systemic antineoplastic treatment can reduce recurrences and death in patients with invasive systemic cervical cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Immunocytochemical demonstration of human immunodeficiency virus infected cells in the cerebrospinal fluid.

Although involvement of the central nervous system represents one of the most common manifestations of the acquired immunodeficiency syndrome (AIDS), a standard diagnostic test for this condition has not yet been established. At necropsy human immunodeficiency virus (HIV) has been demonstrated in brain macrophages in such patients. HIV antigen was detected in CSF macrophages by immunocytochemistry in six out of 11 HIV infected patients. In addition to the detection of intrathecal synthesis of anti-HIV antibodies this method may be suitable for early diagnosis of CNS involvement in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Tracheobronchial lavage--a supplementary measure in the initial management of meconium aspiration syndrome].

Pulmonary lavage - a supplementary measure of resuscitation in newborn infants with severe aspiration of meconium stained amniotic fluid. During 1984-1985 150 mature newborn infants who had aspirated heavily-stained or pea soup-like amniotic fluid were resuscitated at the University Hospital of Obstetrics and Gynaecology in Graz. In 109 of these infants (controls) routine aspiration of both the upper and lower airways was accomplished as soon as possible, whilst in the remaining 41 infants (lavaged) pulmonary lavage with saline was additionally performed via an endotracheal tube after aspiration to clear the trachea and the upper bronchi from thick meconium which could not have been removed as efficiently otherwise. The incidence of manifest meconium aspiration syndrome was significantly higher (22%) in the lavaged infants than in the controls (8%). Mechanical ventilation was performed in 36% of the lavaged infants, whereas only 5.5% of the controls had to be ventilated for more than 1 hour. The mean duration of ventilation, however, was shorter (Mh = 5.1 hrs vs Mh = 69 hrs) and the average age at discharge lower in the lavaged. Three infants died, two of whom had severe malformations. Only one death in the lavaged infants was attributable to severe meconium aspiration syndrome already manifest at birth. Three infants (two lavaged, one control) showed radiological evidence of pneumothorax, but without clinical appearance of respiratory distress. Since the lavaged group naturally contained the more severely distressed infants, with a high incidence of caesarean section on account of intrauterine asphyxia and lower Apgar scores at one and five minutes, the high incidence of radiologically confirmed meconium aspiration syndrome was not surprising.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMed1987

[Labor induction at term: amniotomy versus intravaginal administration of prostaglandin E2 tablets].

This study compares the conventional method for induction of labour, amniotomy (A) with or without oxytocin infusion, with induction by means of intravaginal prostaglandin (PG)-E2 tablets. We reviewed the records of 266 women (A group: 155 women, PG group: 111 women), who had no risk factors at the time of induction. Both methods were effective. However, induction by PGE2 tablets presented less risk and was more comfortable than early amniotomy. We conclude that A should no longer be the method of choice for the induction of labour at term; the application of intravaginal PGE2 tablets is an efficacious, easy, and low-risk alternative.

Administration, Intravaginal↗
PubMed1987

Factor VIII coagulant moiety binds to platelets by binding to phospholipids of the platelet membrane.

Washed human platelets were incubated with commercial factor VIII concentrate, or with purified factor VIII coagulant moiety. Platelets were then washed again and lysed by sonication. VIII:Ag and vWf:Ag were measured in the platelet lysate prior to and after incubation of the lysate with phospholipase C (PL-C). Platelet bound VIII:Ag was significantly higher after incubation of washed platelets with factor VIII concentrate than after incubation with buffer. Platelet bound VIII:Ag was further increased when platelets had been incubated with concentrate in the presence of thrombin and collagen. In contrast, only a slight increase in platelet bound vWf:Ag was observed after incubation of platelets with concentrate. When washed platelets had been incubated with factor VIII coagulant moiety, also significantly more platelet bound VIII:Ag was observed than after incubation with buffer. Measurable VIII:Ag, but not vWf:Ag, increased significantly after incubation of the platelet lysate with PL-C. When intact washed platelets had been treated with PL-C prior to the incubation with concentrate, binding of VIII:Ag to platelets was nearly completely abolished. Our data suggest that the factor VIII coagulant moiety binds to phospholipids of the platelet membrane and thereby contributes to the assembly of the factor X activating complex on the platelet surface.

Blood Platelets↗
PubMed1987

[Studies of obstetric and socioeconomic factors in the origins of prematurity].

Data of 400 term deliveries and 100 preterm deliveries were analyzed to determine the effect of the socio-economic situation, prior abortion, premature birth and other complications on current pregnancy outcome. Of special interest was the question if pregnancy complications in an antecedent pregnancy would lead to intensified care in a following pregnancy. A prior premature birth increases the risk for prematurity significantly. In contrast to earlier studies illegitimacy has no influence on rate and outcome of preterm birth. It is the most striking result of this study that a high risk factor as previous abortion, stillbirth or prematurity gives no cause for improved or intensified prenatal care.

Body Weight↗
PubMed1987

Unusual EEG findings in a case of Creutzfeldt-Jakob disease.

A case is reported of histopathologically verified Creutzfeldt-Jakob disease of long duration (more than 3 years) with some clinical peculiarities. The prominent peculiarity was a nearly normal EEG during repeated examinations, even in the terminal stage.

Adult↗
PubMed1987

Prognostic factors and operative treatment of stages IB to IIB cervical cancer.

Between 1971 and 1985, a total of 325 cases of cervical cancer, Stages IB to IIB, in which operation was performed were evaluated with a view toward prognostic factors and survival rates. In radical abdominal operations, a complete resection of parametrial tissue was the goal. Extensive lymphadenectomy of the pelvis was performed. Operative specimens were processed by giant sections comprising cervix, lateral parametria, and vaginal cuff. Lymph nodes were cut by step-serial sections. Exact measurements of tumor sizes were done along with investigations of parametrium and lymph nodes. Tumors were classified according to a ratio of tumor size to size of cervix. Incidence of lymph node involvement increased with tumor size, reaching a maximum of 68.3% in the group with a ratio from 70% to 80%. Direct spread into the parametrium was rarely found, even in larger tumors occupying the entire cervix. parametrial lymph nodes were most often involved; these were scattered over the entire ligament. Five-year survival rates reached 88.1% in patients with no nodal involvement and 60.9% with nodal involvement. In the latter, the results depended on the number of nodal groups involved and the diameter of metastases. Parametrial involvement alone had no influence on healing rates, but when pelvic nodes were simultaneously involved, the results were less satisfactory. Survival rates based on tumor size differed only between the group with a ratio up to 20% and the large-tumor groups, with rates ranging from 97.5% to 70.9%. There was no statistical difference between Stages IB (31.1% positive nodes) and IIB (44.1% positive nodes) with regard to survival rates (82.2% and 76.9%, respectively).

Aged↗
PubMed1987

[Labor induction by intravaginal administration of prostaglandin E2 tablets].

Between 1982 and 1984, at Graz University Obstetric and Gynaecological Clinic, labour was induced in 307 women (146 primiparae and 161 multiparae) by intravaginal administration of 3 mg prostaglandin (PG) E2 tablets, because birth was overdue or because labour was irregular. No risk factors were present when PG was administered: signs of deficiency or postmaturity, or twisted cord, were ruled out. The following complications were evaluated: birth rate and induction-birth interval in relation to cervical maturity and parity. The number of complications was low. It was unrelated to cervical maturity and only partially to parity. Birth was induced successfully with a single dose of 3 mg PG E2 in over 80% of the primiparae and over 90% of the multiparae. The majority of the primiparae and all the remaining multiparae were successfully delivered with a second dose; no relationship between birth rate and cervical maturity was established. Among the primiparae with a low degree of cervical maturity the child was born within 12 hours in over 50% of the cases, among primiparae with more mature cervices in almost 90%. Among the multiparae, the child was born within 12 hours in 90% of the cases regardless of the state of cervical maturity. It is concluded from these results that with appropriate monitoring of birth, intravaginal administration of PG E2 tablets is an efficient and easily managed method of inducing birth at term, involving little risk.

Administration, Intravaginal↗