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Biomedical subjects

M Kaufmann

Publications and source records attributed to M Kaufmann.

At least 325 records · Page 18Linked to original sources
PubMed1987

[Morphologic criteria of prognosis and clinical course in ovarian tumors of the borderline type].

Borderline tumors of the ovary are morphologically characterized by histologic and cellular criteria and by lack of evidence of invasion. During an observation period of 12 years at Heidelberg University Gynecological Clinic, 49 patients with borderline tumors underwent surgery and the clinical course was followed up. In 15 cases the tumor was at an advanced stage (FIGO III/IV); chemotherapy was instituted after surgery in 12 of these women. None of the patients with early-stage tumors (FIGO I/II) were lost due to the tumor during the period of observation; the death rate among patients with stage III/IV tumors (FIGO) was 40%. However, the death of three of these women was also due to their advanced age and high internal risks. As in the case of ovarian carcinomas, the survival rates improve if the postoperative residual tumor mass is smaller than 2 cm. Subsequent histologic work-up of archived, formalin-fixed tumor tissue and metastases thereof showed that two forms of the metastasizing borderline tumor exist: one with a favorable prognosis, a "pure" form with borderline changes in the ovary and metastases, and one with a less favorable prognosis, with borderline changes in the ovary and destructive-invasive portions of tumor in the metastazation areas. Impulse cytophotometric studies (ICP) showed that all primary tumors had the same degree of ploidy i.e., diploid. However, detection of an aneuploid distribution pattern in a metastasis correlated with subsequent histological confirmation of tumor invasion and rapid tumor death. The S-phase fraction was low, at 2.02% +/- 1.3.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1987

[Clinical course of ovarian cancer in relation to morphologic prognostic factors and cell kinetic parameters].

Apart from the stage of the tumour and the method of surgical approach, factors of special importance in prognosis are the histological type of tumour and the histological and cytological grading of malignant ovarian tumours. To supplement the prognostic factors, DNA flow cytometry has recently been introduced to determine parameters of cell kinetics such as ploidy (the status of the chromosome set in the karyotype) and the number of DNA-synthesized cells. In the present study 81 patients with a malignant tumour of the ovary--most of them classified according to FIGO stage III/IV--were followed up for 12 to 56 months (FIGO = Fédération Internationale de Gynécologie et d'Obstétrique). The survival times are correlated with clinical, morphological and cell kinetics data. The FIGO stage is the most important prognostic factor. None of the patients in stage I/II (FIGO) died during the study period, whereas of 63 women in stage III/IV (FIGO) 41 have already died. The histological tumour type is not so significant for prognosis. The survival curves show that of all the examined prognostic factors in stage III/IV (FIGO) the S-phase proportion (i.e. the proportion of DNA-synthesized cells) is the most important one. Statistically significant differences are also seen in ploidy and in grading. However, in histological grading of tumours the differences are noticeable only in grading G 1 and in grading G 3. G 2 carcinomas--which, by the way, account for one-third of all carcinomas-are a kind of collecting "pool" of tumours whose prognosis cannot be assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Division↗
PubMed1987

[Development of cancer (vulvar cancer) in the Netherton syndrome (ichthyosis, hair anomalies, atopic diathesis)].

So far there has been only one incidence of a malignant tumour associated with Netherton's syndrome, a rare skin disease consisting of congenital ichthyosiform erythroderma, atopic dermatitis and trichorrhexis nodosa (bamboo hair). The aetiology and clinical consequences are discussed on the occasion of a carcinoma of the vulva occurring in a case of a patient with Netherton's syndrome, both phenomena being interlinked.

Biopsy↗
PubMed1986

Distribution of intrapleural and intravenous Corynebacterium parvum in humans; 99mTc-, and 131I-labeled bacteria.

The distribution of Corynebacterium parvum labeled with 131iodine or 99mtechnetium was studied in 17 patients with bronchogenic carcinoma. The labeled bacteria were given intravenously or intrapleurally and monitored by whole-body gamma tracking and samples of blood and urine. Even though the rate of physical decay is quite different for 131iodine and 99mtechnetium, the tracking time of labeled bacteria was limited to 24 h after injection for both radioactive isotopes. Technetium labeling was preferred because of greater imaging resolution and less radiation dose to the patient. Following intravenous administration, labeled C. parvum was found predominantly in the liver and spleen, and in a lesser amount in the lung. Radioactivity was confined to the pleural cavity after intrapleural injection. These results suggest the combined intravenous and intrapleural route of adjuvant immunosupportive agents such as C. parvum for operable lung cancer patients.

Adjuvants, Immunologic↗
PubMed1986

[Successful pregnancy after kidney transplantation and cyclosporin A].

A 21-year-old patient is described who, with a kidney transplant and immunosuppressive treatment with Cyclosporin A, successfully concluded pregnancy. Effective immunosuppression is especially important during pregnancy with its increased risk of transplant rejection. Aside from conventional substances such as azathioprine and steroids, Cyclosporin A (Sandimmun) seems to be the most effective substance available in transplantation medicine today. There is, however, still insufficient knowledge of the effects of Cyclosporin A during pregnancy, so that an endangered pregnancy must be expected during this type of therapy. Because of persistent premature labor in spite of tocolytic treatment, a cesarean section was performed in the 36th week of pregnancy after establishing pulmonary maturity. A review of the literature points out the presently known problems connected with Cyclosporin A intake during pregnancy.

Adult↗
PubMed1986

[The second-look operation in advanced ovarian cancer--experiences since the introduction of cisplatin combination chemotherapy].

In cases of ovarian carcinoma the trend today is toward postoperative cytostatic follow-up therapy which is as aggressive as possible, though of limited duration. The aim is to achieve full clinical remission and to verify it histologically by a second-look-operation. This paper presents the results obtained in 41 women who underwent second-look surgery, out of a total of 87 women with advanced epithelial ovarian carcinoma (FIGO stage III and IV) who had been given combination chemotherapy with cisplatin postoperatively. Taking various well-known prognostic factors into account (stage, age, histologic grading, primary postoperative residual tumor mass), the situation before and after a second-look laparotomy was analyzed. The survival data (life table analyses according to Kaplan-Meier) indicate the importance of these prognostic factors. Approximately one-third of the patients had full clinical remission after aggressive cisplatin combination chemotherapy; complete remission was verified microscopically in 18% of all cases, with a mean of 12 biopsies. The long-term prognosis for such women, who can be cured even if they have primary advanced ovarian carcinoma, is likely to be good. In addition, present-day indications and the standard surgical procedure for a second-look operation are described.

Adult↗
PubMed1986

Prospective randomized trial concerning hyper- and normoprolactinemia and the use of bromoergocryptine in patients with metastatic breast cancer.

This prospective trial was designed to help in selecting therapy for patients with elevated and normal plasma prolactin. Ninety-two patients entered this trial, of whom 86 were evaluable for final analysis. Hyperprolactinemic patients (n = 31) were randomized to receive VAC/FMC chemotherapy with or without bromoergocryptine. Normoprolactinemic patients with 'low risk' metastatic disease (disease-free interval greater than 30 months, ER/PR positive or unknown) were treated with medroxyprogesterone acetate or VAC/FMC chemotherapy. Normoprolactinemic 'high risk' patients (n = 42) (disease-free interval less than 30 months, EP/PR negative) received VAC/FMC chemotherapy with or without medroxyprogesterone acetate (MAP). The results show that bromoergocryptine does not improve response rate, duration of response and survival. Median survival of patients with elevated basal plasma prolactin (greater than 15 ng/ml) is reduced to 9 months compared to patients with normal basal plasma prolactin (17 months, log-rank p = 0.005). Unexpectedly, TRH stimulation proved inappropriate to separate normo- and hyperprolactinemic patients in terms of survival. Normoprolactinemic 'low risks' (tamoxifen failures) were observed to qualify for further hormone therapy (median survival 21+ months). Normoprolactinemic 'high risks' showed median survival of about 12 months with no apparent benefit for those receiving MAP, additionally. The results suggest that basal hyperprolactinemia, disease free interval, ER/PR receptor status, and liver metastasis are important prognostic variables. Endocrine and cytotoxic chemotherapy should be selected according to these risk factors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Characterization of breast carcinomas by two monoclonal antibodies distinguishing myoepithelial from luminal epithelial cells.

Two monoclonal antibodies, KA 1 and KA 4, raised against human epidermis, were biochemically and immunologically characterized and were shown to react with specific cytokeratin polypeptides. On frozen sections of human mammary gland, these antibodies distinguish between myoepithelial and luminal epithelial cells. We present evidence that in these cells KA 1 antibody recognized cytokeratin 5 and KA 4 antibody cytokeratin 19. In normal mammary tissue, KA 4 antibody invariably reacted with the epithelial cells lining the lumina of acini, ductules, ducts, and sinus. In contrast, KA 1 antibody decorated only the myoepithelial and basal epithelial cells of acini, ducts, and sinus. In ductules, however, KA 1 also stained the luminal cells. All 73 invasive lobular and ductal carcinomas studied reacted with KA 4 antibody; five of these were also positive, apparently in the same tumor cells, with KA 1. The tumor cells of in situ carcinomas were also stained in a homogeneous pattern with KA 4 antibody; KA 1 antibody reacted only with the surrounding myoepithelium. In epithelial hyperplasias, the proliferating cells were decorated by KA 1 and KA 4 antibodies in a heterogeneous pattern. Other antibodies were used for comparison. The results are discussed with respect to epithelial differentiation and pathogenesis and to the application of such antibodies for immunohistodiagnosis of mammary lesions.

Adenoma↗
PubMed1986

[Compliance in adjuvant chemotherapy].

The study presented deals with the issue of therapy compliance on the example of female patients with breast carcinoma, who had received adjuvant chemotherapy. Catamnestic results are reported for 44 patients who had answered a complaints questionnaire and participated, additionally, in unstructured interviewing on the problems and strain experienced during and following therapy. The study group consisted of 10 women who had dropped out of treatment, and 34 women who had followed the treatment as scheduled. The physical and emotional strain found are reported, and discussed from the perspective of therapy compliance. Of particular interest in this context is the doctor-patient-relationship, i.e. the question of how the patients' subjective considerations and medical cost-benefit calculations could be heeded in as open and trustful an exchange between doctor and patient as possible.

Adult↗
PubMed1985

[Diagnosis of benign and malignant ovarian tumors].

The present paper reports on the value of gynecological-clinical examinations and preoperative ultrasonography in the diagnosis of benign and malignant ovarian tumors. Out of a group of 42 patients, in all of whom "ovarian cyst" had only been diagnosed clinically, 14% were not found to be suffering from this condition at surgery. In a comparison of preoperative gynecological-clinical and ultrasonographic findings (in 68 patients) it proved possible to determine the side on which the tumor was localized, its actual size, the extent to which it was delimited from the uterus, and its consistency (whether solid or cystic) significantly better by ultrasonography (p less than 0,01). However, the results of this study indicate that 2% of the cases diagnosed ultrasonographically as "benign ovarian tumor/ovarian cyst" are likely to be ovarian carcinomas. In the group of patients with malignant ovarian tumors also (42 patients), there was a significant difference in the preoperative diagnosis "suspected ovarian carcinoma". On the basis of clinical findings it was only diagnosed in 45%, while it was found in 74% by ultrasonography (p less than 0,01). In 3 cases with ovarian carcinoma there was no pathologic palpation finding, and in only one other case was a "suspected ovarian cyst" diagnosed. By means of ultrasonography, on the other hand, all of the cases of ovarian carcinoma were classified either as "ovarian carcinoma" or as "cystic-solid/complex abdominal tumor". The most frequent diagnoses on the basis of the sonographic scan (approx. 90%) were cystic-solid ovarian tumors, followed by cystic-ventriculated ovarian tumors with solid portions and finally solid ovarian tumors with only a few cystic portions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

DNA flow cytometry of ovarian tumors with correlation to histopathology.

Tissue samples from 49 women with seven benign and 42 malignant ovarian tumors were examined by means of DNA flow cytometry (FCM). The FCM data (DNA-ploidy and the number of S-phase fractions) were compared with the International Federation of Gynecology and Obstetrics (FIGO) stage, the histologic grade of differentiation and in some cases with the clinical outcome. The benign ovarian tumors were all diploid with a mean of 2.1% (+/- 1.66) S-phase fractions. Adenocarcinomas with the histologic grade 1 were diploid and had a mean of 2.1% (+/- 1.17) S-phase fractions. Grade 2 adenocarcinomas were aneuploid in eight of nine cases and revealed an increased proliferative activity (7.7% +/- 2.67 S-phase fractions). A high number of aneuploid cases (nine of 13) and an increased DNA synthesis were found in grade 3 adenocarcinomas (12.0% +/- 5.72 S-phase fractions). Four of six malignant nonepithelial tumors also had high numbers of S-phase fractions (9.7-14.5%). A significant correlation between the histologic grade and the DNA synthesis, FIGO stage, and DNA-ploidy was found. DNA-FCM may be used as an additional diagnostic tool supplementing routine histopathologic examination of ovarian tumors for better biological characterization, especially for those with uncertain grading, for grade 2 neoplasms, and for malignant nonepithelial tumors.

Adenocarcinoma↗
PubMed1985

[General management and operative therapy of progressive or recurrent ovarian cancer].

High relapse rates and poor therapeutical results of a secondary chemotherapy or of surgery and radiation can be expected in advanced ovarian carcinoma. Supportive care must stand in the foreground of therapeutical attention. Furthermore, intraperitoneal forms of therapy (radioisotopes or cytostatic agents) must be tried out. Rectal obstructions occur in about 35% of all patients. A successful operation leads to a prolongation of the survival time.

Combined Modality Therapy↗
PubMed1984

[DNA measurement of malignant tumors by impulse cytophotometry. The principles and importance for assessing growth behavior and the degree of abnormality].

Monometric DNA impulse cytophotometry of ploidism state (diploid or aneuploid tumors with stemmline shift, polyploidism ) and proportion of DNA-synthesized cells (S-phase proportion) were determined on over 500, mostly malignant, tumors of different sites. The results were compared with histopathological findings (TNM stage and degree of differentiation). Large diploid carcinomas of the oral cavity have lower S-phase activity than aneuploid tumors. Carcinomas of the breast, stomach and ovary are frequently diploid. Aneuploid carcinomas of these regions generally have high synthesizing activity. Mucoid signet-ring carcinomas of the stomach have lower S-phase activity than non-mucoid carcinomas. In the colorectal region aneuploid carcinoma predominates, in the colon more than in the rectum. Tumor metastases from colon and rectum into the liver predominantly are from aneuploid primary tumors. For tumors of the breast, corpus uteri and ovary with high and moderate differentiation there is a direct correlation between histological grade of differentiation and the S-phase proportions. Aneuploid tumors vary from low to high synthesizing activity. Diploid meningioma and glioma have a low S-phase proportion, aneuploidism correlates with an increase in growth. Supplementation of histopathological diagnosis by determining ploidism and S-phase activity makes an important contribution in the assessment of the degree of malignancy, as well as for therapeutic purposes.

Aneuploidy↗
PubMed1984

Combination chemotherapy (VAC/FMC) with immunostimulation in metastatic breast cancer: a randomized study comparing different times and routes of administration of Corynebacterium parvum.

From January 1978 to December 1980, 222 patients with metastatic breast cancer were included into a prospective multicenter trial. All patients were treated once a month with six cycles of VAC- (vincristine, adriamycin, cyclophosphamide) chemotherapy, followed by FMC (5-fluorouracil, methotrexate, cyclophosphamide) until progression was documented. By random assignment, the patients received immunostimulation with Corynebacterium parvum (CP) by one of four methods: subcutaneous (SC) on either day 1 or day 14, intravenous (IV) on either day 1 or day 14. The 214 evaluable patients were equally distributed to the four arms. The rates of complete or partial response to VAC/FMC plus CP did not differ significantly between the treatment groups. Of our patients, 22-33% were definite treatment failures. The Kaplan-Meier curves of duration of remission (medians 14 vs. 9 vs. 13 vs. 11 months) did not differ significantly. Only small differences in survival were noted among the four study groups (medians 15.4 vs. 17.5 vs. 17.2 vs. 13.0 months). However, complete and partial responders lived significantly longer (Log rank test P = 0.008), when CP was given on day 14 by the SC rather than IV route (29+ vs. 14.3 months). Patients in the four study groups were treated with virtually identical doses of VAC/FMC chemotherapy. Patients receiving CP intravenously on day 14 experienced significantly lower mean leukocyte counts than patients in the other groups. Many patients suffered from high temperature (requiring treatment with antipyretics) and severe gastrointestinal toxicity, particularly when CP was given IV on day 1 together with the chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗