Search PubMed⌕ Search

Biomedical subjects

W Kuhn

Publications and source records attributed to W Kuhn.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

Docetaxel is effective in the treatment of metastatic endometrial cancer.

BACKGROUND: Systemic treatment of endometrial carcinoma with distant metastases is currently performed, inter alia, with anthracyclines, platinum, paclitaxel, if osfamid or progestins. This is the first report presenting experience in treatment of metastatic endometrial carcinoma with docetaxel. CASE REPORT: A 69-year-old women with adenocarcinoma of the endometrium was treated with primary combined radiotherapy. Two years later disseminated bilateral pulmonary metastases were detected and the patient was submitted to chemotherapy with epirubicin. After three cycles of chemotherapy with epirubicin examinations revealed metastatic progression. Thus, chemotherapy was changed to docetaxel. RESULTS: After three cycles of chemotherapy with docetaxel examinations revealed remission of the described pulmonary metastases more than 50%. A further three cycles of chemotherapy with docetaxel lead to continuing shrinkage of the detectable metastases to less than 25% of the original size. Because of various side effects, like increasing fatigue and asthenia, uncomfortable acral paresthesia and allergic skin reactions, the patient refused to continue chemotherapy. CONCLUSION: We conclude that docetaxel may be an active agent in patients with metastatic endometrial cancer, but care should be taken to minimize side-effects.

Adenocarcinoma↗
PubMedDate not supplied

Comparison of different histopathological methods for the examination of sentinel lymph nodes in breast cancer.

BACKGROUND: Sentinel lymphonodectomy is a new method for the classification of axillary lymph nodes in breast cancer. The optimum technique for the pathological examination of sentinel lymph nodes (SLNs) is still under debate. MATERIALS AND METHODS: Different histopathological techniques were evaluated in order to study their diagnostic accuracy regarding the detection of metastases in 49 SLNs of 40 breast cancer patients. RESULTS: In single hematoxylin and eosin (HE) stained paraffin sections 18 out of 40 patients showed positive SLNs and 8 out of 40 showed positive axillary lymph nodes (ALNs). Serial sections with a spacing of 150 microns between following sections revealed an additional 4 and 5 cases with positive SLNs and ALNs, respectively. Single HE frozen sections showed 11 tumor positive SLNs among 25 patients. The ultrarapid-immunohistochemistry on single frozen sections confirmed these data and detected one additional case with isolated tumor cells in the lymph node sinus. CONCLUSION: Histopathological nodal staging of SLNs should include serial sections with a spacing of 150 microns between sections as well as immunohistochemistry. The ultrarapid-immunohistochemistry is a sensitive method for the detection of minimal metastatic disease in SLNs and can be applied intraoperatively.

Adult↗
PubMedDate not supplied

[Diagnostic and therapeutic problems in HELLP syndrome].

The HELLP syndrome is a severe and life-threatening complication of preeclampsia. Despite obstetricians are more aware of this syndrome maternal and perinatal mortality could not be reduced during the last years. The diagnostic problems of the HELLP syndrome are early detection of the disease, problems concerning differential diagnosis to other diseases with similar symptoms, and the different definition of the HELLP syndrome itself. For early detection of hemolysis determination of serum haptoglobin should be included in laboratory screening methods. Manifestation of DIG is not a principal sign of the HELLP syndrome but reflects a secondary pathophysiological process of the primary disease. Therefore administration of heparin and antithrombin III is not indicated and may lead to induction or amplification of life-threatening bleedings in these cases. Conservative approaches have shown to improve the fetal and maternal condition in individual cases, however, termination of pregnancy is the only definitive cure for patients with HELLP-syndrome. With respect to our perinatal results (n = 84) immediate delivery, predominantly by caesarean section, is recommended after diagnosis has been confirmed.

Cesarean Section↗
PubMedDate not supplied

[Changes in the basic immunologic parameters interleukin-2 receptor and CD8-antigen in pre-eclampsia].

The serum level of interleukin-2 receptor (sIl-2R) and CD-8 antigen were determined as basic parameter in terms of the stimulation of the t-cell mediated immune reaction in patients suffering from pre-eclampsia (n = 21), HELLP syndrome (n = 12) and pre-existing hypertension (n = 10). The data were compared with those of healthy nonpregnant female volunteers (n = 10) and normotensive pregnant women in the course of pregnancy. Hypertension in pregnancy was associated with an increase of sIl-2R and sCD-8 levels depending on the severity of the hypertensive disorder. In the group of patients with severe pre-eclampsia the median of sIl-2R serum level increased from 370 U/ml (normotensive patients) to 730 U/ml and that of sCD-8 from 640 U/ml to 1100 U/ml. In patients with pre-existing hypertension there was a smaller increase of sIl-2R (median 520 U/ml) and decrease of sCD-8 (median 520 U/ml). 6 to 8 weeks after delivery in the group of hypertensive patients the sIl-2R levels were normalized and the levels of sCD-8 were elevated (median 1030 U/ml). The results support the hypothesis of T-cell mediated immunological reactions as pathogenetic factors of the genesis of the hypertensive disorders in pregnancy.

Adult↗
PubMedDate not supplied

[Measuring subcutaneous fatty tissue as a sonographic parameter for detection of fetal growth retardation and fetal hypertrophy in pregnancy].

This investigation contains a statistical evaluation of sonographic results concerning fetal subcutaneous adipose tissue aiming to examine and assess the relevance of this new sonographic parameter for the detection of fetal growth retardation, resp. fetal hypertrophy during pregnancy. The diagrammatic presentation of the growth of the subcutaneous adipose tissue of eutrophic fetuses shows low validity for the differentiation of hyper- and hypotrophic fetuses. To enable the differentiation between "asymmetric" and "symmetric" types of retardation, the different degrees of growth of the subcutaneous adipose tissue of hypertrophic fetuses have to be taken into consideration. The relation between birthweight and growth of the subcutaneous adipose tissue shows no distinct differentiation of the birthweight, however, presents overlapping categories of the birthweight for diagnostic orientation.

Adipose Tissue↗
PubMedDate not supplied

[Gaucher disease and pregnancy].

Two pregnancies in a patient with Gaucher's disease type I are reported. Anemia and thrombocytopenia were augmented during pregnancy, but no effect on the spleen and liver was observed. The first delivery was associated with a severe post partum haemorrhagia (platelet count 56,000/mcl, hemoglobin before delivery 10.2 g/100 ml, postpartum 5.5 g/100ml). At the end of the second pregnancy the platelet count was 33,000/mcl. Platelet transfusions were given after induction of preterm labor and no bleeding complications were observed. The obstetric aspects of Gaucher's disease are reviewed. Post partum haemorrhagia is associated with thrombopenia and is observed in patients with platelet counts under 100,000/mcl. Platelet infusions are recommended before delivery in these patients. Thrombocytopenic patients should be carefully monitored during labor with crossmatched blood on standby.

Adult↗
PubMedDate not supplied

[Morphologic and biochemical aspects of prostaglandin-induced cervix ripening].

For examination by electron microscopy tissue samples were taken from the posterior lip of the cervix of 8 patients having a termination of pregnancy at 9-12th week gestation and 16 patients of comparable gestational age who had an intracervical application of either 2 ml 5% tylose or 50 micrograms sulprostone-tylose gel 8 hours before biopsy. The efficacy of cervical priming was demonstrated objectively by tonometric studies. In addition, collagenase and protease activities were determined in the cervical tissue extracts of the different treatment groups. For identification of typical collagen fragments SDS-polyacrylamide-gel-electrophoresis were carried out on the acetic acid soluble extracts. The local application of sulprostone gel induced a marked multifocal loosening of the collagenous framework; there was no evidence for leucocyte infiltration or necrosis caused by the prostaglandin (PG) pretreatment. In the areas of disorganized collagen fibres cervical fibroblasts seemed to be activated characterized by fine granular loosening of the cytoplasma, dilated cisternae of rough endoplasmatic reticulum, vacuolized enlarged mitochondria and an increased number of cytoplasmatic vesicles close to the cell surface. Collagenase and protease activities were found in all extracts of the different treatment groups, however, PG-application led to no significant increase in enzymatic activities. There was no evidence for the presence of typical collagen cleavage products in the SDS-electrophoresis. Contradictory to the hitherto published literature enzymatic collagen degradation does not play an essential role in PG-induced cervical ripening.

Abortifacient Agents↗
PubMedDate not supplied

[Prevention of habitual abortion by buffycoat transfusions].

From an immunological point of view the product of pregnancy may be regarded as a haplo-different allotransplant. A system possibly closely linked to the HLA-region is postulated to lead to the immunological recognition of the fetus by the mother and, paradoxically, to a take of the "transplant". The postulated system apparently codes for antigens present on both trophoblast and adult lymphocytes (TLX = trophoblast-lymphocyte-crossreacting). The prevention of rejection is thought to be effected by blocking factors (BF) present in the serum or plasma of the mother. There may be different kinds of BF: a specific BF (detectable only in an autologous assay system), appearing late in pregnancy, which inhibits several lymphocyte-dependent reactions (e.g. production of MIF, MLC). This BF has been identified as an IgG-class antibody. a nonspecific BF, appearing early in pregnancy which inhibits the MLC in vitro. c) may be a third BF, also specific, which is found only in plasma but not in serum. All described BF-activities were absent in women with habitual abortions. HLA-identity or partial identity could imply TLX-identity. The consequence of such an identity could be: non-detection of the trophoblast by the immune system of the mother, no production of BF, abortion. However several investigators could not find any HLA-identity of the partners with habitual abortions. A protective effect on the fetus has been seen when pregnant women were immunised with adult leukocytes, using either buffycoats from various HLA-different but bloodgroup-compatible donors or isolated leukocytes from the spouse.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Habitual↗
PubMedDate not supplied

[Relation between procoagulant activity and fetal lung maturity in amniotic fluid].

A total of 146 samples of amniotic fluid from the 15th to 43rd weeks of pregnancy were taken by either transabdominal amniocentesis or amniotomy during birth. In addition to the palmitic/stearic ratio (P/S) the following coagulation tests were determined: clotting time, modified prothrombin time, partial thromboplastin time (PTT), recalcification time and, in selected samples, thrombelastograms. In the course of pregnancy there is a significant shortening of all coagulation tests measured in amniotic fluid. Comparing the values obtained in the 15th to 18th and the 37th to 43rd weeks of gestation and literature results the following values may indicate fetal maturity: clotting time less than 100 sec., modified prothrombin time less than 80 sec., PTT less than 30 sec. and recalcification time less than 80 sec. The lower limit for P/S ratio in normal pregnancy is 5,0. In 58 cases, amniotic fluid was obtained in the 37th to 43rd week at most 24 hours before delivery; there was no case of RDS in this group. Eliminating intermediate P/S values of 4,5 to 5,0 a false negative rate of 1,7% for the prediction of fetal lung maturity was seen. The corresponding rate for the modified prothrombin time was 3,4% and for the clotting time 6,4%. In 7 RDS cases all cases could be properly predicted from the recalcification time and the PTT. The fetal lung maturity may be estimated by means of simple and rapid coagulation tests and this may facilitate the indication for RDS-prophylaxis. The determination of the L/S or P/S ratios, however, cannot yet be dispensed with.

Amniotic Fluid↗
PubMedDate not supplied

[Labor contraction-dependent changes in magnesium and calcium in the myometrium].

Magnesium is commonly used in the therapy and prevention of preterm labor. Therefore the differences of the concentrations of magnesium and its antagonist calcium were measured in the human myometrium to examine the interaction of labour and ionic changes. The ionic concentration in the myometrium of 37 patients without labour are determined and the values are compared to the data of 26 patients in active labour. Women of the first group without labour had a magnesium concentration of mean = 4.1 mmol/kg wet weight and a calcium concentration of mean = 2.9 mmol/kg wet weight. Women of the second group with active labour have a significantly lower (p < 0.01) magnesium concentration (mean = 3.5 mmol/kg wet weight). However, the calcium level (mean = 2.7 mmol/kg wet weight) does not show significant differences. These results indicate that the decrease of magnesium plays an important role in the physiology of parturition. A low magnesium concentration in the myometrium might have a considerable influence on premature labour in the third trimester of pregnancy. Therefore a prophylactic application of magnesium seems to be useful.

Adult↗
PubMedDate not supplied

[Immunization with partner lymphocytes: improvement of pregnancy rate in sterility patients].

In a two-centre prospective study 20 patients with a history of unsuccessful sterility treatment underwent immunization with paternal lymphocytes to improve the pregnancy rate in the subsequent therapeutic AIH or IVF/ET cycle. Unsuccessful sterility treatment was defined as no pregnancy after 8 properly monitored AIH cycles and at least one diagnostic IVF/ET or more than 3 IVF with transfer of 3 embryos. After successful immunization expressed by the induction of Fc-receptor blocking antibodies 10/20 patients became pregnant. Nine of these patients delivered healthy children, one patient experienced a first trimester abortion. A successful second pregnancy occurred in 6 of these patients. No significant correlation between the previous history and pregnancy success could be found, except a slight advantage for patients with a history other than tubal sterility. There were no differences in the anamnestic data as well as in the success rate between the two independent centres Göttingen and Leuven (10 patients each). These data suggest, that adjuvant immunotherapy might improve markedly the pregnancy rates in selected cases of sterility.

Abortion, Habitual↗
PubMedDate not supplied

[Normal pregnancy duration after maternal Fontan operation of univentricular heart].

Up to now pregnancy in patients with a previous Fontan operation for definitive palliation of a univentricular heart has been regarded as contraindicated. Two cases of a pregnancy after Fontan operation and univentricular heart were published in the literature. In a single case a successful delivery of the fetus could be achieved. The presented case is the third published pregnancy after Fontal operation and the second with a successful fetal outcome. The 30 years old patient was born with a univentricular heart of right ventricular type with tricuspid and pulmonary atresia and persisting arterial duct. After bilateral Blalock Taussig anastomoses (1966) and modified Waterston-Cooley-anastomosis (1974) a primary existing cyanosis could be improved. The cyanosis was completely abolished after definitive repair with the Fontan operation at the age of 17 (1980). The course of pregnancy and its surveillance is reported. In the 32nd week of gestation cesarean section had to be performed because of threatening cava compression. A healthy female fetus of 1275 g was delivered. The mother's postoperative recovery was uneventful. Meanwhile the neonate and the mother have been discharged and are in good clinical condition.

Adult↗
PubMedDate not supplied

Prognostic significance of p105 (c-erbB-2 HER2/neu) serum levels in patients with ovarian cancer.

BACKGROUND: Elevated serum levels of the oncoprotein p105 (c-erbB-2, HER2/neu) have been found in patients with ovarian cancer, but its role in this disease has not been clearly established. MATERIALS AND METHODS: The authors studied the relationship between p105 serum levels, various tumor parameters, and survival in 57 patients with newly diagnosed, untreated ovarian cancer. Serum specimens were obtained at the time of initial surgery, and p105 levels were determined using the human neu quantitative ELISA assay. RESULTS: Elevated p105 serum levels were correlated with a poor prognosis since patients with low p105 levels had a better survival than patients with high p105 levels (P = 0.02). This result was confirmed in stage III patients (n = 29; P = 0.08). p105 serum levels were not related to tumor stage, grade, histologic findings or serum CA 125 levels. CONCLUSIONS: Our results suggest that ovarian cancer patients with elevated p105 serum levels may have a poor clinical outcome.

Adolescent↗
PubMedDate not supplied

Mib-1 evaluated proliferative activity in ovarian cancer with respect to prognostic significance.

In the present study, tumor tissue of 251 patients with ovarian cancer was immunohistochemically analysed for proliferative activity using the monoclonal antibody mib-1 and the analyse system CAS 200. The rate of the growth fraction varied from 0% to 71% mib-1 positive tumor cells with a median of 17%. There was a strongly significant association between proliferative activity and the degree of histological differentiation (p = 0.0005), whereas there was no significant correlation with tumor stage and histological subtypes. Using the median as the cut-off point, patients with higher proliferating tumors (> or = 17%) had a statistically significant worse prognosis (p = 0.0431). Especially in the group of patients with grade 1 and grade 2 tumors, measurement of the proliferative activity is of help for prediction of the postoperative survival time of patients (p = 0.0336), suggesting that measurement of the growth fraction estimated by mib-1 reflects more closely the degree of tumor differentiation. However, multivariate analyses cannot confirm these results.

Adolescent↗
PubMedDate not supplied

Serum levels of the c-erbB-2 (HER2/neu) encoded oncoprotein fragment p105 in normal pregnancies.

The c-erbB-2 encoded oncoprotein p185 is overexpressed in fetal epithelial cells, in the placenta, and in several human carcinomas. Elevated serum levels of the 105 kD extracellular part are found in cancer patients and in pregnancy. Our purpose was to examine whether there is a characteristic development of p105 serum levels in the course of normal pregnancy. Using ELISA, we measured the p105 serum concentrations in nonpregnant women, women with normal pregnancy in the 1st, 2nd, and 3rd trimester and pueperas. Compared to nonpregnant women, we found a significant decrease in p105 in the 1st and 2nd trimester, followed by a significant increase in the 3rd trimester. Post partum serum values returned to the levels found in nonpregnant women. The clinical judgment of female p105 serum values requires comparison with the normal range of random samples, and the consideration of pregnancy and the age of gestation as in vivo influencing factors.

Enzyme-Linked Immunosorbent Assay↗
PubMedDate not supplied

[Obstetric aspects of maternal hepatitis C infection].

The present study discusses problems of maternal infection with hepatitis C virus in pregnancy with respect to the recent publications on this subject. In particular, questions of vertical transmission during pregnancy and fetal infection sub partu are discussed using three cases as an example. It was shown that recently few informations on the risk of transmission of the hepatitis C virus from the mother to the infant in utero or sub partu are existing, but the actual studies provide some evidence for this risk to be relatively low. The actual knowledge concerning the mode of delivery of hepatitis C positive women as well as recommendations concerning the diagnostic and therapeutic procedures are comprehensively shown on the basis of the recent scientific results.

Adult↗
PubMedDate not supplied

Results of postoperative radiotherapy of cervix carcinoma after radical versus non radical hysterectomy.

UNLABELLED: We studied the outcome of our 68 cervix carcinoma patients treated either with: 1) radical surgery and postoperative 192Ir high-dose rate afterloading brachytherapy or postoperative radiotherapy to the whole pelvis or with 2) standard hysterectomy and postoperative radiotherapy to the whole pelvis. Forty-eight women were treated by radical hysterectomy from 1988 to 1992 and--due to risk factors--by postoperative radiotherapy (Group 1), 20 other patients (Group 2) pretreated with standard hysterectomy were admitted to the university hospital for postoperative radiotherapy of the whole pelvis. Postoperative radiotherapy consisted of 39.6 Gy total dose using the box technique, plus two afterloading applications with a single dose of 7.5 Gy and 6 Gy external beam therapy to the pelvic lymph nodes sparing the midline. Comparing the Kaplan-Meier plots of both groups, the tumor related survival curve, the locoregional control and the rates of metastatic disease were nearly identical. But in the analysis of special subgroups, patients with positive lymph nodes after standard hysterectomy and postoperative radiotherapy had a worse prognosis (75% three years' survival rate) than patients after radical surgery (86% three years' survival rate). Lymphangiosis was a negative prognostic factor for the patients pretreated with standard hysterectomy (60% versus 80% three years' survival rate), but not for patients after radical surgery (80% three years' survival rate), despite the same radiotherapy in both groups. CONCLUSION: Standard hysterectomy fails to be an adequate treatment for early cervix carcinoma because moderately dosed postoperative radiotherapy cannot achieve complete locoregional control in all cases of positive lymph nodes or invasion of lymph vessels. However, based on the empirical results of many authors and our own results, postoperative radiotherapy is further indicated in high risk cases of cervix carcinoma after radical surgery.

Female↗