Biomedical subjects
Publications and source records attributed to J Zander.
A big chorioangioma in an uncomplicated pregnancy and delivery in the 39th week of pregnancy is reported. The child was completely normal. The prevalence, aetiology, pathological and sonographic differential diagnoses and possible complications are discussed.
Misinterpretations of urogenital malformations are frequent despite partly intricate and costly diagnostic methods. The problems to be tackled until a correct diagnosis is eventually obtained, are demonstrated by means of a case report on a patient with uterus communicans, a rare malformation (only 31 cases have been published in the international literature to date).
The significance of various radiographic signs in 183 patients with clinically occult breast disease is described. 30.6% had a carcinoma of the breast or a carcinoma in situ. The radiological features have varying predictive values and there is variation in the incidence of lymph node metastases. It is considered useful to classify the radiological appearances under the headings of round foci, star-shaped opacities, diffuse opacities, opacities with calcification and groups of micro-calcification. Despite the early diagnosis, 24% of patients already had lymph node metastases.
Five of six acutely manic patients treated with dextroamphetamine experienced a 50% or greater reduction in their mania severity scores. Side effects were noted in only one patient. The treatment results suggest that dextroamphetamine might be useful in the treatment of mania.
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The authors analyzed the dexamethasone suppression test (DST) results of 54 patients with major depressive disorder in relation to their pre-DST levels of cholesterol, sodium, potassium, and blood glucose, which are thought to have adrenocorticotrophic links. Discriminant analysis revealed that sodium alone was a significant predictor of nonsuppression. Validation of the predictive power of sodium could minimize the need for DST administration.
This study evaluated the prognostic value of different morphologic tumor parameters in 13 cases of malignant melanoma. Tumor thickness correlated well with survival. The prognostic index--tumor thickness multiplied by the number of mitoses per square millimeter--was useful in predicting metastasis risk.
In 13 patients, mean age 57 (31-78) years, with malignant melanoma of the vulva, 7 of the tumors occurred on the Labia majora, 4 on the Labia minora and 2 on the clitoris. 8 cases involved nodular malignant melanomas, 2 cases each involved a superficial-spreading form and an acrolentiginous form, and one case involved a non-classifiable malignant melanoma. According to histological criteria 10 of 13 tumors showed a high risk of metastasising. At the time of diagnosis one of the patients was in stage II and one in stage III of the disease. Of the 13 patients, 6 died, as a result of the tumor, 5 within the first 2 years. The mean survival time was 15 (6-28) months. In three other cases the disease has reached an advanced stage: stage Ib, II or III. Up to now only 4 patients have remained symptom free, the symptom free interval averaging 62 (33-84) months. This investigation confirms the special characteristics of malignant melanomas of the vulva, which are the predominance of tumors having a bad prognosis and the rapidly progressing course of the disease.
Various methods of tissue sampling are used to verify histologically a clinical carcinoma of the cervix. The question arises whether or not diagnostic cone biopsy has any influence on the treatment and/or the clinical course of this disease. The clinical and histological data and the follow-up of 185 patients with squamous cell carcinoma of the cervix were statistically evaluated. We found no difference between patients with or without cone biopsy in respect of complications, frequency of metastases or recurrences, and survival. However, our deliberations permit the following statement: cone biopsy is an appropriate method to diagnose cervical intraepithelial neoplasia (CIN) or microcarcinoma of the cervix and may--under certain conditions--even be the adequate therapy. However, cone biopsy lacks any advantage over other diagnostic methods if it is employed merely for the purpose of histological verification of clinical carcinoma of the cervix.
The article reports on first experiences with the stereotactic diagnosis device "Mammotest" in the diagnosis of diseases of the breast. Preoperative stereotactic carbon marking of non-palpable changes requiring clarification via mammography was successful in 94% of the cases. With the stereotactic cytological clarification by means of Nordenström's cannula the high rate of cellular material which could not be clarified, was unsatisfactory. Stereotactic histological punch biopsy in case of unclear mammographic findings enables exact localisation of the punch and histological examination of the punch biopsy. Mammographic follow-up did not yield any false negative finding to date.
The retrospective study reported here, which covered 2116 patients operated on, indicates that postoperative complications are more likely to occur in women aged over 60 than in younger patients. There is also a connection between the patient's age and previous internal disease, the surgical approach, and the severity of the change requiring surgery. The connection between age and postoperative complications is principally explained by previous internal disease. Patients with malignant tumors are at greater risk than women with benign genital changes. Carcinoma cases apart, these patients are older and have suffered more from previous internal disease. While postoperative morbidity and mortality rates are higher among older patients, the percentage of complications occurring is so low that age does not represent a contraindication to gynecological surgery.
There have always been controversies on the pros and cons of home delivery and childbirth in a hospital. During the Nazi regime, the official "health command" policy monitored by the Nazi party promoted home delivery under midwife supervision, both by pertinacious propaganda and partly also by decrees and ordinances. The official line of argument against clinical obstetrics consisted of a queer and highly questionable mélange of ideology and distored facts brought forward by the so-called "Reichsgesundheitsführer" Dr. Leonardo Conti and his mother, Mrs Nanna Conti as head of the Party-sponsored Midwives Association. The "Midwives Law" was promulgated on 21 December 1938 prescribing compulsory consultation of a midwife for every delivery. By the end of 1939 gynaecologists eventually rallied in protest against legislative measures to restrict clinical obstetrics, by means of a memorandum penned by the German Association for Gynaecology. This memorandum was scheduled for circulation among all the members of the association. The pressure exercised by this memorandum resulted in tough negotiations amounting to a tug-of-war between representatives of the German Association for Gynaecology and Dr. Conti. This led eventually not only to an abandonment of the attacks against clinical obstetrics but also to an official and unreserved recognition of its achievements. In addition, the "Reichsgesundheitsführer" issued "Directives for regulating obstetrics procedures" in 1940/41 in which it was laid down that it would be left to the decision of the expectant mother to choose where she would prefer to deliver her child.
Treatment results of 1,092 patients with operated cervical cancer, covered by a cooperative program including the Departments of Obstetrics and Gynecology of four universities, were analysed. Standardized surgical procedures and histological processing of the surgical specimens were employed throughout. The indication to postoperative radiotherapy was different in the different university departments. In order to carry out a realistic comparison of the achieved treatment results, not the clinical staging, but the tumour extension histologically determined on the surgical specimen, was taken into account. In cases presenting a continuous tumour growth corresponding to histological Stage Ib, the 5-year-survival rates achieved were 90.5% and 95.6% for patients only operated, or operated and subjected to radiation therapy, respectively. In cases of continuous tumour growth corresponding to histological Stage II, the 5-year-survival rates were 79.5% following surgery only, and 83.1% after surgery and radiation. The differences between the corresponding survival rates were not statistically significant. The further proof of tumour parameters and the formation of twin pairs, revealed that the prognosis of patients presenting unfavourable tumour criteria could not be influenced by a postoperative radiation therapy.
In a 41-year old tertipara with twin pregnancy, foetal chromosome analysis showed a boy without abnormal findings, 46, XY, and a boy with free trisomy 21. Abortion of the abnormal twin was performed in the 23rd week of pregnancy via sectio parva. Despite preoperative onset of tocolysis and ultimately performed circular suture of the cervix, premature rupture of the membranes occurred in the 28th pregnancy week, followed by spontaneous birth of the second twin weighing 1010 g. Raising of the premature baby did not present any special problems.
83 anovulatory patients refractory to clomiphene were treated with gonadotropin releasing hormone (GnRH) in pulsatile form (Zyklomat). 146 of 172 treated cycles were ovulatory. A total of 37 pregnancies occurred. The patients were classified into three groups according to the degree of severity of their cyclic disturbance and according to the results of testosterone determinations. In amenorrhoic women with normal testosterone values (group I) the authors found the highest incidence of ovulation and pregnancies. In the patients of group II the ovulation rates were high, whereas the incidence of pregnancies was low (this group comprised anovulatory oligomenorrhoea and normal testosterone values). It was found that about 30% of the anovulatory women with elevated testosterone levels (group III) were refractory to therapy, the proliferation phases being mostly considerably prolonged during the ovulatory cycles. It is concluded from the results of this study that in women with normoandrogenemic amenorrhoea the treatment of first choice should be pulsatile application of GnRH. In many hyperandrogenemic, anovulatory patients treatment with gonadotrophins should be considered as the presently more suitable method.
Treatment results of 1092 patients with operated cervical carcinoma were evaluated and assessed on the basis of data supplied by four University Clinics of gynaecology. Surgical treatment and histological processing of all surgical specimens were uniform. Indication for postoperative radiation was determined differently at the individual clinics. The treatment results obtained can be compared with one another not on the basis of clinical stage assessment; the only criterion is the histologically proven extension of the tumour, ascertained via an examination of the surgically obtained specimen. With continuous tumour growth in accordance with stage Ib, the 5-year survival rate after surgery alone was 90.5%, after additional radiation 95.6%. In case of continuous tumour growth in accordance with stage II, the 5-year survival rate after operation alone was 79.5%, after operation and radiation 83.1%. The differences in the 5-year survival rates are statistically not significant. Taking into consideration a discontinuous metastatic tumour growth in the region of the parametric tissue, the 5-year survival rate after operation alone was 72.7%, after subsequent radiation 75%, in case of metastases in the region of the lymph nodes 77.8% and 60.5%, respectively. These differences in survival rates were not statistically verifiable. Furthermore, if individual tumour parameters were tested and statistical pairing was performed, it became evident that prognosis of patients with infaust tumour criteria could not be influenced by postoperative radiation.
Increases in blood pressure and heart rate often seen with endotracheal intubation during induction of anaesthesia and with extubation during termination of anaesthesia are dangerous for many patients. In 20 patients pretreated with urapidil, a new antihypertensive agent, changes in blood pressure and heart rate were compared with the haemodynamic parameters of 20 untreated patients. 0.6 mg/kg urapidil are given before induction of anaesthesia and 0.4 mg/kg +/- 0.2 mg/kg urapidil before its termination. The results show that urapidil is a suitable drug to avoid dangerous increases in blood pressure during such situations, without producing hypotension. Therefore urapidil is recommended as a supplementary therapy in high risk patients.
The endocrinologic methods used in the dexamethasone suppression test (DST) for depression were examined, by employing two different doses of dexamethasone (0.5 or 1.0 mg) at 11 p.m. Nonsuppression to the 1.0 mg DST (plasma cortisol criterion value of 5 micrograms/dl) was seen in 33% of major depressives and in 15% of schizophrenics. A similar result was obtained with the 0.5 mg DST when 12 micrograms/dl was employed as the plasma cortisol criterion value. Plasma cortisol levels 33 hours postdexamethasone did not distinguish between major depressives and schizophrenics.