[An attempt to qualify and quantify scientific congresses].
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Austria↗
Biomedical subjects
U Haller
Publications and source records attributed to U Haller.
[Gynecological management of patients over 80 years old. Results of a prospective study].
OBJECTIVE: Diagnosis and therapy of gynecologic inpatients who were over 80 years of age were analyzed with respect to the desired and the actual management. METHODS: A general assessment protocol for diagnostic and therapeutic steps which were not carried out in individual cases was drawn up and used for the 96 patients analyzed. The desired therapy corresponded to the ideal management of a 60-year-old patient. RESULTS: In two thirds of the cases, the desired therapy could be given. For 32 patients, there was a reduction of 5-50%; for only 2 patients one of > 50%. The most frequent deviation from the ideal therapy was for the oncologic patients. CONCLUSIONS: Our conclusions agree with those reported in the literature, namely that age alone can not be taken as an argument against standard treatment of a patient with a gynecologic disorder. For patients over 80 years of age, the individual risks and benefits of a particular therapy, especially when surgery is involved, should be carefully considered.
Aged↗
["Others talk about it...we do it". Quality assurance for graduate and continuing education].
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Curriculum↗
Assessment of effect of photosensitizers on cytotoxicity of photodynamic therapy in human breast cancer cell cultures.
BACKGROUND: Photodynamic therapy (PDT) might be of clinical value for patients with breast cancer with local recurrences or metastasis. However, there is a need for improved photosensitizers that are effective in combination with laser light and have few, if any, side-effects. We evaluated in vitro the effectiveness of a second generation photosensitizer by testing the influence of laser light on cell cultures of a human breast carcinoma cell line, incubated with meta-tetrahydroxyphenylchlorin (m-THPC) (= Temoporfin). EXPERIMENTAL DESIGN: Five thousand MCF-7 cells were plated in 96-well plates. Forty-eight hours before laser treatment, the cells were plated to achieve a monolayer configuration. Twenty-four hours after plating, they were incubated with m-THPC. On day 6 after treatment with m-THPC we lysed the cells to extract the intracellular ATP that correlates with the number of living cells. The ATP-CVA was used to assess the cytotoxicity of the tested photosensitizer m-THPC at various concentrations and the relevant laser light alone prior to their combination after six days of culture. RESULTS: We found a dose-response for m-THPC alone ranging from 2 to 16 micrograms/ml. The calculated inhibition concentration to produce 50% cell kill (IC50) was 4.55 micrograms/ml. We also observed a very low cytotoxicity for laser irradiation alone but a very strong cell kill for the combination of m-THPC together with laser light. CONCLUSIONS: PDT gave almost total cell kill at m-THPC concentrations that are not toxic in vitro.
Adenosine Triphosphate↗
Single-use versus reusable laparoscopic surgical instruments: a comparative cost analysis.
OBJECTIVE: Our purpose was to determine and compare the total annual costs for reusable and single-use laparoscopic instruments. STUDY DESIGN: Records were kept over a 12-month period of all laparoscopic operations (performed only with reusable instrumentation), the surgical instruments used, depreciation costs, and all associated expenses (repairs, maintenance, replacements, cleaning, sterilization, wages). The total cost was then calculated and compared with the total cost (purchase price plus disposal fees) that single-use instruments would have caused for the same operations. RESULTS: The total cost for single-use instruments would have been more than seven times that for reusable instruments. CONCLUSION: We have decided to continue using reusable instruments for most of our laparoscopic operations. However, single-use instruments are used in situations in which they present a definite advantage. A proper balance is thus sought between the importance of cost factors, on the one hand, and the recognition of the need for the best instrument available for certain procedures, on the other.
Costs and Cost Analysis↗
Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.
OBJECTIVE: To assess the reproducibility of a new method for evaluation of the bladder neck with perineal ultrasound and to compare it with lateral chain urethrocystography. METHODS: In the first phase, two investigators examined 40 patients using perineal ultrasound to assess the reproducibility of a new measurement method for the determination of the bladder neck position. In the second phase, 60 patients were evaluated by perineal ultrasound and lateral chain urethrocystography. RESULTS: With perineal ultrasound, there was good interexaminer agreement for determining bladder neck position, funneling, and bladder neck descent at rest and during the Valsalva maneuver, but not for the posterior angle beta during straining. Comparison of sonographic and x-ray assessments showed good agreement for the bladder neck position at rest, but not during Valsalva, whereas the posterior angle, funneling, and bladder base descent differed between the two techniques at rest as well as during Valsalva. CONCLUSION: With our new method for determining the position of the bladder neck, perineal ultrasound is a reliable technique that allows reproducible static and dynamic evaluation. Lateral chain urethrocystography is superior to perineal ultrasound only if bladder neck funneling is the aim of the evaluation; it is inferior if bladder neck mobility during maximal Valsalva is being investigated.
Female↗
Improvement of perineal sonographic bladder neck imaging with ultrasound contrast medium.
OBJECTIVE: To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy in perineal ultrasound. METHODS: In 39 women with clinically and urodynamically proven urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was administered transurethrally and perineal ultrasound was performed. Women were examined in the upright position both without and with ultrasound contrast medium at rest and during Valsalva maneuver, and the pictures of the bladder base, bladder neck, and urethra were compared. RESULTS: With the subject in the upright position, the contrast medium lay at the lowest point of the bladder and resulted in a reverse picture of the bladder base and bladder neck and clear visualization of these structures. In women with urinary stress incontinence, the ultrasound contrast medium entered the urethra during Valsalva, and bladder neck funneling was identified more accurately than without contrast medium. With Echovist, bladder neck funneling was detected in 38 of the 39 cases, compared with only 19 when it was not used. Furthermore, when the bladder neck, urethra, or bladder base were not visible with plain perineal ultrasound, they were seen when ultrasound contrast medium was used. The contrast agent was well tolerated, and there were no adverse side effects. CONCLUSION: The use of ultrasound contrast medium improves visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence.
Adult↗
[Measuring the death of invasion of endometrial carcinoma. Preoperative transvaginal ultrasound and correlation with intraoperative and histopathologic findings--a prospective study].
AIM: Determination of the correlation of the assessment of depth of invasion in endometrial cancer by transvaginal ultrasound, and by intraoperative assessment with histopathology. METHOD: In this study 25 patients with endometrial cancer diagnosed by dilatation and curettage were examined by means of transvaginal ultrasound. The sonographically assessed depth of invasion (inner or outer half of the uterus wall) was compared with the intraoperatively determined depth of invasion in the sectioned uterus. Finally, we correlated these findings with histopathology. RESULTS: Transvaginal ultrasound and the intraoperative assessment of depth of invasion had and accuracy of 80% if correlated with the definitive histopathology. The result of the frozen section was correct in all analysed cases. We also evaluated the wrong assessments in the ultrasound group and in those patients who were assessed intraoperatively. In all these cases there were additional pathological findings, such as polyps, fibroids and uterus retroflexus. CONCLUSION: We conclude that especially in such cases frozen section analyses yield helpful information on the depth of invasion and should be performed routinely.
Adult↗
[Evaluation of perineal ultrasound examination--are the results reproducible?].
UNLABELLED: Perineal ultrasound was used with a new measurement method that locates the urethrovesical junction. The aim of this study was to test the reproducibility of this examination. Two different investigators examined 40 patients at rest and during Valsalva's manoeuvre. Using a rectangular coordinate system, the bladder neck was located by means of distance measurements. In addition, the retrovesical angle beta was measured as described by Green, and certain anatomical signs were noted. There was a good inter-examiner correlation (r values 0.77-0.92) both at rest and during Valsalva for the distances and angle beta. There was good agreement in the analysis of the anatomical signs. CONCLUSION: Perinatal ultrasound, together with the measurement method described in this paper, is a reliable technique for determining the bladder neck position, for measuring angle beta and for analysing anatomical signs. This method permits a quantitative evaluation and quality control of therapeutic procedures.
Female↗
[Value of the adenosine triphosphate chemosensitivity assay for pre-therapeutic determination of the chemosensitivity of breast cancer cells in cell culture].
UNLABELLED: This presentation gives a summary of the chemosensitivity test results in breast cancer using the ATP-Cell-Viability Assay (ATP-CVA). Other assays and test systems for chemosensitivity testing are also evaluated. Our results with the ATP-CVA in breast cancer cell lines showed that this test system is a reproducible and reliable tool in the screening of new drugs. Our results with drug combinations showed that with the ATP-CVA and the "median effect principle" synergistic and antagonistic effects can be reliably calculated. The application of the ATP- CVA in fresh human breast cancer made it possible to test tumor chemosensitivity in individual patients. We found an evaluability rate of the ATP-CVA of 95% in 116 patients. The chemosensitivity profiles of the tested tumors revealed a big heterogeneity of chemosensitivity results for single and drug combinations. The 22 in vitro/in vivo correlations from patients with metastatic breast cancer treated with at least three cycles of chemotherapy showed a sensitivity of the ATP-CVA of 92% and a specificity of 89%. CONCLUSIONS: These data are encouraging and further investigations on chemosensitivity testing of fresh tumours are currently ongoing in a prospective study at the University of Zurich.
Adenosine Triphosphate↗
[Multivariate analysis of clinico-pathologic predictors of axillary lymph node metastasis in invasive breast carcinoma].
UNLABELLED: The aim of this study was to find both predictors of axillary lymph node involvement and predictors of level II or III involvement. With these predictors patients should be selected who can be spared axillary lymph node dissection or who qualify for removal of only first-level lymph nodes. 239 consecutive patients with invasive breast cancer stage I-III treated with total axillary dissection were evaluated. In multiple logistic regression analysis 17 clinical and histopathological variables were included. We found 4 multivariate significant predictors for metastatic axillary involvement: Clinically positive axilla, peritumoural lymphatic vessel invasion, multicentric or multifocal tumours and a large number of past pregnancies. Multivariate significant predictors of involvement of level II or III were peritumoural lymphatic vessel invasion, younger age, larger tumour size, multicentric or multifocal tumours and postmenopausal patient. The metastatic involvement of more than 3 nodes was associated with young age and clinically positive axilla. With these easily available predictors a reliable assessment of risk of metastatic involvement of the upper levels of the axillary nodes could be defined. The binary logistic regression model to axillary node involvement had a rather unsatisfactory predictive value. CONCLUSIONS: The risk calculation of level II or III involvement with these predictors may help the surgeon to find the adequate extent of axillary clearance needed in the individual patient. Multiparity proved to be an independent predictor of metastatic axillary node involvement.
Adult↗
Photomedicine of the endometrium: experimental concepts.
Gynaecological photomedicine offers new diagnostic and therapeutic methods based on the interaction of light with the reproductive organs. One example is photodynamic therapy (PDT) in which photosensitizers are applied systemically or topically for selective endometrial ablation. Several studies describing the potential use of PDT for this application are reviewed. Basic experimental and clinical aspects of PDT, such as photosensitizer types, application modes, irradiation parameters, optical properties of tissues and photodegradation of photosensitizers are discussed.
Animals↗
In vitro chemosensitivity of paclitaxel and other chemotherapeutic agents in malignant gestational trophoblastic neoplasms.
This is the first report on the ATP cell viability assay as a chemosensitivity test system for gestational trophoblastic neoplasms (GTN). We obtained chemosensitivity profiles in two established trophoblastic cell lines and four fresh tumors. Ten drugs were tested in vitro in the two cell lines JAR and JEG-3. The IC50 values of the 10 chemotherapeutic agents tested were very similar for both cell lines. The three most active drugs in these cell lines were VP-16, paclitaxel and vincristine. This is the first report on the activity of paclitaxel in trophoblastic cell lines. We furthermore evaluated this assay for chemosensitivity testing in four fresh malignant GTN tumors: one placental site trophoblastic tumor, one chorocarcinoma and two invasive moles. The placental site trophoblastic tumor specimen revealed to be rather chemoresistant in vitro whereas the other three tumors were chemosensitive. From our cell line data we conclude that the ATP cell viability assay is a practicable assay for chemosensitivity testing of GTN cell lines and gives repeatable results. However, the value of this assay for fresh GTN chemosensitivity testing needs to be defined.
Adenosine Triphosphate↗
[Gynecologic examination: perceptions, fears and expectations of polyclinic patients].
OBJECTIVE: What kind of expectations, desires and fears do patients have concerning the pelvic examination, and is it possible to improve the procedure? METHODS: We asked 1,061 women of our gynecological outpatient clinic using a questionnaire. RESULTS: 48% said that the pelvic examination caused no problem at all, while nearly every third patient felt tense and uncomfortable. 75% of the women wanted explanations during the examination, which had to be carried out in the absence of a third person in 46%. The same percentage said that it did not matter. 53% had no preference of gender concerning the examiner, 37% preferred a female doctor and 10% gave preference to a male one. CONCLUSIONS: The pelvic examination, which is mainly associated with reluctance and discomfort of the patient, does not seem to be experienced like this by almost half of our patients. It is easily possible to ameliorate the procedure, for example by explaining the findings during the examination and by complying with the gender preferences of the patients as much as possible.
Adolescent↗
[Persistent ductus omphaloentericus--a possible cause of bleeding umbilicus].
We report the case of a 23-year-old woman with a persistent omphalomesenteric duct. The diagnosis was verified by histology. Further differential diagnoses of bleeding umbilicus are the urachal fistula and endometriosis.
Adult↗
[Transvaginal ultrasound of "placental-site trophoblastic tumor"].
The case of a placental-site trophoblastic tumor (PSTT) is described. Transvaginal sonography revealed a vascularized tumor mass with a deep invasion of the myometrium, partly with echogenic, solid parts and partly multiple echo-free cystic lesions. The maximum size of an echo-free cystic lesion was 4.4 cm. Doppler exploration indicated the presence of blood flow in all these cystic lesions. Distinctly abnormal low flow indices were prominent in the whole tumor area. According to the clinical results and the slightly positive levels of human chorionic beta-gonadotropin (100-1,000 IU/l postpartum), this tumor was classified as malignant trophoblastic disease, most likely PSTT. The authors conclude that, in the case of a patient with suspected trophoblastic disease and in view of the sonographic findings, PSTT may be a valid differential diagnosis, particularly if larger cystic lesions of more than 3 cm in diameter are found in the tumor bed together with evident blood flow at a low vascular resistance.
Adult↗
[The combined use of photodynamic therapy with ionizing radiation on breast carcinoma cells in vitro].
PURPOSE: The photodynamic therapy is a technique by which the tumor cells are selectively sensitized to destruction by light of an appropriate wavelength. The aim of this work is to analyze the biological effectiveness of photochemical reactions induced by laser light in tumor cells exposed to photosensitizers. MATERIAL AND METHODS: The toxicity of the 2 photosensitizers zinc phthalocyanine (ZnPC) and meso-tetrahydroxyphenylchlorine (m-THPC) as well as the biological effect of the combination of sensitizers with laser light were tested in vitro by means of a colony forming assay. In addition, the influence on the photodynamic reaction of a previous exposure of the tumor cells to ionizing radiation has been tested. RESULTS: For both sensitizers doses of 5 micrograms per milliliter of culture medium showed low toxicity, i.e. the survival of the treated cells exceeded 90%. For laser treatments the dose permitting 90% survival was determined to be around 10 J/cm2. With these doses, the combined application of photosensitizers and laser light proved to be very effective and resulted in a nearly complete reduction of survival. As expected, irradiation of the cells with doses of 1 and 2 Gy of X-rays reduced the survival to 66 and 47%, respectively, compared to untreated controls. Cells surviving such treatment showed no changes either in the response to treatments with photosensitizers or to combined applications of photosensitizers and laser light. CONCLUSION: The effects of photodynamic treatment by ionizing radiation seem to be additive and independent of each other. So, our preliminary results are quite encouraging and point out the need of further detailed studies in view of the intended clinical application of this new kind of a local treatment.
Breast Neoplasms↗