[Clustered microcalcification in mammography?].
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Artifacts↗
Biomedical subjects
N Lang
Publications and source records attributed to N Lang.
The patterns of expression of an apoptosis-related CK18 neoepitope, the bcl-2 proto-oncogene, and the Ki67 proliferation marker in normal, hyperplastic, and malignant endometrium.
Expression of a neoepitope on cytokeratin 18, recognized by the monoclonal antibody M30, is an early indicator of apoptosis in epithelial cells. The aim of this study was to determine the equilibrium between apoptosis (M30), anti-apoptosis (bcl-2), and proliferation (Ki-67) in different endometrial conditions. Paraffin-embedded samples (n = 107), representing proliferative endometrium (18), secretory endometrium (19), postmenopausal endometrium (15), disordered proliferative endometrium (6), simple hyperplasia (12), complex hyperplasia (8), and endometrial adenocarcinoma (29), were evaluated immunohistochemically. The indirect streptavidin-biotin-horseradish peroxidase technique, with 3-amino-9-ethylcarbazole as the chromogen, was used to visualize the reactions. Proliferative endometrium showed high bcl-2 and Ki-67 expression levels with no M30. In the secretory phase, the balance was tipped in favor of M30 with a decrease of bcl-2 and Ki-67. Postmenopausal endometrium revealed high Ki-67 and bcl-2 expression levels and no M30. In complex hyperplasia, M30, bcl-2, and Ki-67 showed increased expression. In endometrial carcinoma, an increasing reactivity for M30 and Ki-67 was seen as the grade progressed. bcl-2 reacted weakly and only in grade 1 cancer. Immunohistochemistry facilitates the study of the expression of proteins related to cyclic endometrial activity. Interruption of these cyclic events is associated with specific disturbances in the expression patterns of these proteins.
Apoptosis↗
Comparison between critical pathway guidelines and management of deep-vein thrombosis: retrospective cohort study.
AIM: To compare the key steps of standard deep-vein thrombosis management with the critical pathway practice guidelines, and to assess the outcome of the treatment after 6 months. METHOD: This retrospective cohort study (from January 1, 1997 to December 31, 1998) included 172 patients with uncomplicated deep-vein thrombosis of lower extremities, consecutively admitted via emergency room. The data were collected from the entry register in emergency room and medical charts. The outcome of therapy was assessed 6 months after the acute event. RESULTS: A bolus dose of heparin was administered to 81 (46%) patients. The recommended initial heparin infusion rate at 1250 U/h was employed in only 26 (15%) patients. Time to activated partial thromboplastin time >60 s was met in 29 (17%) patients. All patients but one received heparin therapy longer than 96 h. The recommended time to a therapeutic international normalized ratio of less than 120 h was achieved in 134 (78%) patients, but the average length of a stay in the hospital exceeded the recommended 5. 5 days by 86%. Six months later, compressive ultrasonography revealed 44 (28.9%) cases of complete vein obstruction, 67 (44.1%) cases of partial recanalization and 41 (27%) cases with a normal finding. Recurrent thrombosis developed in 16 patients (10.5%) and acute pulmonary embolism in 4 (2.6%) patients. CONCLUSION: Our results considerably differ from the critical pathway guidelines due to the lower initial heparin doses and longer diagnostic assessment of thrombosis etiology. Our approach to deep-vein thrombosis treatment was a combination of the critical pathway guidelines and the conventional regimen. The clinical outcome in our series did not differ significantly from the outcome after the conventional way of treatment.
Cohort Studies↗
Nitric oxide synthase activity and Doppler parameters in the fetoplacental and uteroplacental circulation in preeclampsia.
OBJECTIVE: We investigated the hypothesis that changes in blood flow in the uteroplacental and fetoplacental circulation in preeclampsia are associated with an abnormality of placental or uterine placental bed nitric oxide (NO) synthesis. METHODS: We measured pulsatility indices on Doppler waveform analysis from uterine and umbilical arteries in 20 patients with preeclampsia and 14 healthy pregnant controls before elective cesarean section. During cesarean section, biopsies from the uterine placental bed and the placenta were taken and the nitric oxide synthase (NOS) activity was measured by the [3H] L-arginine-[3H] L-citrulline conversion assay in these samples. RESULTS: The NOS activity was significantly lower in the uterine placental bed in comparison to the placental tissue (p < 0.01). Placental NOS activity was similar between patients with preeclampsia and healthy controls and in the groups with either a pathological or a normal Doppler flow in the umbilical artery. In the uterine placental bed however, NOS activity from patients with preeclampsia was significantly lower (p < 0.01), whereas the blood flow resistance in the uterine arteries was elevated (p < 0.01) in comparison to healthy controls. CONCLUSIONS: Our data show that pathological Doppler waveforms in the uterine arteries of patients with preeclampsia are paralleled by diminished NOS activity in the uterine placental bed. Therefore, the compromised NO production in the uterine placental bed may play an important role in the impaired uteroplacental blood flow and potentially in some pathological features of preeclampsia such as intervillous thrombosis formation and fetal growth retardation.
Adult↗
Distribution and concordance of N-acetyltransferase genotype and phenotype in an American population.
Polymorphic arylamine N-acetyltransferase 2 (NAT2) status varies widely between individuals and ethnic groups and has been associated with susceptibility to several cancers. Few studies have reported the distribution of NAT2 status for Caucasian-American populations or evaluated the concordance between methods of assessment for cancer cases and controls. In our study, distribution of NAT2 status was classified by genotype and phenotype measurements in PANCAN, a population-based case-control study of pancreatic cancer, and concordance between measurements was evaluated for 33 cases and 222 controls. Major genotypes and alleles among controls were *5B/*6A, *5B/*5B, *4/*6A, and *5B/*4. One putative new allele was found in a single individual. Genotypes and phenotypes were classified as rapid or slow, according to a bimodal model. Presence of the *4 (wild-type) allele defined a NAT2 genotype as rapid. The NAT2 phenotype was analyzed by the caffeine assay. Ratios of 5-acetylamino-6-formylamino-3-methyluracil to 1-methylxanthine were determined, and individuals with values of > or =0.66 were identified as having a rapid phenotype. In our population, 58.1 and 59.5% of control subjects were classified as slow acetylators by phenotype and genotype, respectively. Concordance of NAT2 genotype and phenotype classification was 97.8% in the bimodal model. A similar analysis was completed for a trimodal model. Concordance of genotype and phenotype was high in cases (90.9%) and similar to controls; genotyping alone provided an efficient, accurate method of analysis for acetylator status. A comparison with two previous reports revealed subtle differences in genotype and allele distribution but exhibited overall similarity with other Caucasian-American populations.
Aged↗
[Pelvic wall recurrence of cervix carcinomas. Combined surgical-radio-chemotherapeutic procedure (CORCT)].
PURPOSE: The prognosis of patients with pelvic wall recurrences after primary therapy of cervical cancer is bad. In selected patients treated exclusively by surgery as primary therapy the 5-year survival rate was between 5 and 25%. Additionally the combination of operation and radiotherapy (CORT) improved the survival so far. We developed a new concept for the treatment of pelvic wall recurrences. This concept includes the combination of radical surgery, interstitial radiation and chemotheray--CORCT (combined operative- and radiochemotherapy). PATIENTS AND METHODS: After radical surgery, interstitial HDR (Ir-192) brachytherapy in afterloading technique (2.5 Gy, 2 fractions/day in 5 days) was performed. Additionally a chemotherapy with cisplatin 25 mg/m2/day in 5 days and 5-fluorouracil 1000 mg/day in 5 days was applicated. RESULTS: After combined operative- and radiotherapy 3 of 3 patients died after treatment within 8 months (median) because of distant metastases. After additive radiochemotherapy 3 of 4 patients had no evidence of disease (NED) after a follow-up period of 14 (12 to 30) months. CONCLUSION: The first treatment results of the new designed combined operative- and radiochemotherapy concept (CORCT) led us to expect an improvement of the prognosis of patients with recurrences of cervical cancer at the pelvic wall.
Adult↗
Prognosis of children born to mothers with HELLP-syndrome.
In literature there have been differences in the assessment of the outcome of children born to mothers with HELLP syndrome. In a retrospective study we investigated six annual groups (1989-1994) at the Perinatal Center in Erlangen (11,235 births, 68 children of mothers with HELLP syndrome), 53 children were treated in our neonatal intensive care unit (NICU). The control group (n = 219) consisted of a complete age group in our NICU. The gestational age (mean 33 weeks, p < 0.003) and the birth weight (mean 1671 g, p < 0.001) were significantly lower in the HELLP group. No significant differences were detected with respect to the frequency of leucocytopenia (p = 0.518) and thrombocytopenia (p = 0.215). Despite a relatively high rate (37.7%) of RDS there was only a significant tendency to the disadvantage of HELLP children (p = 0.075). There was no difference in frequency of intracranial hemorrhage (ICH) (p = 0.566). Infections were diagnosed less frequently in HELLP children (p = 0.042). Mortality in the control group was higher only as a tendency (p = 0.07). The follow-up examinations of the neurological development covered 31 of the 53 treated children. After 6-72 months (median 24 months), 90.3% of these children showed normal development or only minor disabilities. The prognosis of children of mothers with HELLP syndrome is not as bad as has been assumed so far.
Female↗
[What is the role of Doppler color sonography associated with echo-signal enhancing levovist in complementary breast diagnosis?].
At the women's hospital of the University of Erlangen we performed a prospective clinical study to evaluate the use of color Doppler imaging supported by the new echo contrast agent Levovist in comparison to clinical examination, B-mode sonography, mammography, and MRI. In 40 patients the sensitivity and specificity of each method was estimated in predicting the dignity of palpable or mammographically detectable tumors of the breast. Prior to and after administration of Levovist we recorded the number of vessels, the PI, RI, SD-ratio, and maximum flow velocity after correction of the angle. Color Doppler imaging of the tumor and the surrounding tissue was documented on video tape for five minutes after the administration of Levovist. We measured the time until an increase and decrease in color signal was detectable. The following sensitivities/specificities were found: clinical examination 57.1% (12/21)/73.7% (14/19), B-mode sonography 100% (21/21)/84.2% (16/19), mammography 100% (21/21)/89.5% (17/19) and MRI 92.3% (14/15)/78.6% (15/18). Without the contrast agent color Doppler imaging could not differentiate between malignant and benign lesions. There was no significant difference in the perfusion of benign and malignant tumors. However, after the administration of Levovist, there appeared to be a significant difference for SD-ratio. With a cut-off-level of 3.5 we found a sensitivity/specificity of 85% (17/ 20)/78.6% (11/14) for the Doppler method. There was a weak correlation between the time of appearance of the augmented Signal in color Doppler and the velocity of enhancement of the contrast agent in MRI (n = 24, r = 0.47, p = 0.02). Only with the use of a contrast agent was color Doppler ultrasound able to support the other methods in pre-operative differentiation of benign and malignant lesions in the breast.
Adult↗
[Value of 99mtechnetium-MIBI scintigraphy in breast diagnosis].
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Adult↗
Increase of serum tumor marker concentrations by interferon-alpha.
Since it has been shown that the addition of interferon-alpha to ovarian cancer cells in vitro leads to an increase of CA125 in the cell culture supernatant it was the aim of our study to investigate whether the CA125 serum concentrations of patients with ovarian tumors could also be increased by injection of interferon-alpha in vivo. Nine patients with cystic ovarian tumors received 6 million IU interferon-alpha subcutaneously. CA125, CA15-3, and CEA were measured in defined time intervals during the following three days after interferon-alpha injection. In one patients with T1a N0 M0 ovarian cancer with normal serum levels of all markers before interferon-alpha application a massive increase of CA125 serum concentration was detected three days after injection. In the other 8 patients (5 benign tumors, 3 ovarian cancers) no marker increase was observed. In concordance with observations in cell cultures an increase of CA125 serum concentration after interferon-alpha injection was seen in one patient with early ovarian cancer and initially normal CA125 levels. If by the injection of interferon-alpha an increase of CA125 could regularly be induced in ovarian cancer patients, earlier detection of ovarian cancer seems possible.
Adult↗
[Interventional methods in breast diagnosis. Histological vs. cytological evaluation of core cut biopsies of the breast].
High speed core cut biopsies of breast tumors, sonographically or stereotactically guided, allow an histological examination of the tumor without surgery. It can be used prior to operation for the confirmation of a breast cancer and it can avoid unnecessary breast surgery in benign tumors. Unfortunately, only some centers are equipped with a pathology unit that allows an immediate histological examination. But often these institutes are provided with an experienced cystologist. Thus, the question arises if a cytology taken from the core cut biopsy is as reliable as an histological examination. In a prospective study we performed unroll-cytologies in core cut biopsies of 173 breast tumors in 169 patients consisting of 122 malignant and 51 benign tumors. Histology of core cut biopsies was proven by operational histology in all malignant and in 5 benign tumors. Histology of core cut biopsies could not be judged in 2 cases (lymphoma, gallert carcinoma). Cytological slide preparations were technically inadequate in 4 cases. The false negative rate of histology was 1/120 and 27/120 in cytology. Histology compared with cytology showed the following results: sensitivity 99.2% versus 77.5%, specificity 100% versus 95.9%, positive predictive value: 100% vs. 97.8%, negative predictive value: 98.1% vs. 63.5%, and accuracy: 99.4% vs. 82.8%. The sensitivity of cytology was much worse than that of histology of core cut biopsies. Thus, in our opinion cytology can provide a quick diagnostic orientation, but it cannot replace the more reliable histological examination. Diagnostic or therapeutic decisions should be based upon the more reliable histological results.
Biopsy↗
Delayed interval delivery in a twin pregnancy with monochorionic placenta.
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Adult↗
[Interventional techniques in breast diagnosis: ultrasound controlled puncture biopsy].
From May 1, 1992 to April 30, 1993, we performed 307 ultrasonic guided, high-speed core cut biopsies. In 119 of the 307 women, we dispensed with further surgical and histological procedures when the tentative diagnosis from complementary mammary diagnostic procedures revealed no pathological findings and concurred with the histological results of the core cut biopsy. In 188 women, the biopsy was followed by surgical intervention and correlation of the histological findings. This group of patients showed a sensitivity of 98%, a specificity and positive predictive value of 100%, and a negative predictive value of 91%. If we combine the results of the complementary mammary diagnostics (including the core cut biopsy), then the sensitivity, specificity, and positive and negative predictive values for this surgically and histologically confirmed group of patients reach 100%. In trained hands, the ultra-sonic-guided, high-speed core cut biopsy is a reliable means for determining the histological nature of lesions detected in ultrasonic scans. This technique has been perfected in our facility. Along with preoperative carcinoma detection, it permits us to avoid unnecessary operations when, under defined conditions, there are no pathological findings.
Adolescent↗
Implant dentistry--development and current focus.
Today, implant dentistry plays an important role in the maintenance of chewing function and oral health. For thirty years now oral implants and methods for implantation have been developed further to assure a lifetime stability of these devices and to optimize function and esthetics. Starting with the treatment of fully edentulous patients, oral implants are now used for the reconstruction of partially edentulous patients as well. Thereby, implants not only replace missing teeth but also help to preserve intact remaining teeth. They are usually incorporated to improve the patient's subjective chewing comfort. The present paper gives an overview of the development and the current state of the art of oral implants, as well as their clinical indications.
Animals↗
[Significance of roentgen mammography for breast carcinoma screening].
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Adult↗
[Champagne administered by spoon for peritonitis after cesarean section. From the history of obstetrics in Erlangen--data from about 60,000 deliveries in 100 years].
The University of Erlangen has been engaged in clinical obstetrics for approximately 170 years. During this time, Erlangen University's delivery house, opened in 1828 and at first having considerably less than 50 births a year, developed into a perinatal centre with approximately 1,700 births a year. For the period from 1880 to 1981, a group of MD students reviewed the existing records and evaluated 60,000 births with respect to more than 40 parameters. Part of the results obtained are shown with special reference to operative obstetrics. Apart from the general influence of the scientific development on decisions and results within obstetrics, individual factors were also recognizable, factors which are linked with the experiences, insights and specialized working areas of the particular head of the hospital.
Cesarean Section↗
[Quality assurance in stereotactic punch biopsy using a phantom].
Lesions of the breast, which were only defined by mammography, can histologically be clarified by stereotaxic high-speed core cut biopsy. In a quality control procedure we have proved the accuracy of the localization unit and the biopsy equipment. A new acrylic-glass phantom allows visual detection of localization faults in the z-axis (direction of biopsy) for the first time with minimal coefficients of variation in all three axes. Quality control in the stereotaxic biopsy of breast lesions is absolutely essential for the practical use of this method.
Biopsy, Needle↗
[The dosage-performance effects on Ca-Ski and HPK cells in relation to the dose and fractionation].
BACKGROUND: The steep decrease of dose and dose-rate in brachytherapy implies very different radiobiological considerations of the biological effectivity. MATERIAL AND METHODS: Therefore, in imitation of the clinical procedure, we compared the LDR-, MDR- and HDR-brachytherapy. We carried out experiments on epidermoid cervix carcinoma cells (Ca-Ski cells) and human primary keratinocytes (HPK cells) obtained after transfection with human papillomavirus type 16 DNA varying the dose-rate (28 cGy/h to 8000 cGy/h), the dose (1 Gy to 100 Gy) and fractionating (protracted, 3, 6 and 12 fractions). RESULTS: 1. At dose-rates of 75 cGy/h (Ca-Ski cells) and 110 cGy/h (HPK cells) respectively we found that the cells "fall asleep" at doses up to 100 Gy; the rate of cell mortality is insignificantly higher than the proliferation rate. 2. A first-time proof of an accumulation of repopulation effects (recovery from the sublethal radiation damage, progression of the cells during the partial cycle/proliferation and the acts of redistribution), if the radiation exposure reaches the median time of the cell cycle (HPK cells, dose-rate: 110 cGy/h, doses: 1 Gy to 100 Gy). 3. Each increase in the dose-rate requires higher fractionating. At dose-rates higher than 300 cGy/h (range of a percutaneous radiotherapy), we found that the survival rates of the cells could only be increased insignificantly in spite of a fractionated therapy (3, 6 or 12 fractions; doses: 1 Gy to 100 Gy); the repopulation effects almost vanished. CONCLUSIONS: Changing a LDR- into an HDR-brachytherapy the equivalent factors close to the source have to be selected low and with increasing distances from the source high respectively higher-the major problem for a mathematical formula. The reduction of the dose in HDR-radiation therapy is a compromise in order to limit side effects caused by a radiation. The trade-off is a small therapeutic range and reduced therapeutic effectivity at the tumor. The percutaneous dose at the pelvis wall has to be reduced if at the same time an HDR-brachytherapy will be carried out-to avoid side effects.
Brachytherapy↗