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Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

246 records · Page 14Linked to original sources
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↗
PubMedDate not supplied

Epidermal growth factor receptor-immunohistochemical detection and clinical significance for treatment of primary breast cancer.

Epidermal growth factor receptor is considered to play an important role in the carcinogenesis and progression of breast cancer, but its clinical significance remains controversial mainly due to different methods and methodical problems. We determined EGF-R expression by an immunohistochemical assay on paraffin-embedded primary breast cancer tissue by means of the anti EGF-R mab E30 (Merck, FRG) and streptavidin-peroxidase technique. Material and clinical data were available from 111 patients with a mean follow-up time of 75.4 +/- 1.1 months (range 61-90 months). 21 (18.9%) of the breast cancer specimens showed positive staining for EGF-R 5 year-overall survival in patients with EGF-R negative tumors was 61.7% compared with 41.6% of patients with EGF-R positive breast carcinomas. No correlation was found between the expression of EGF-R and other prognostic factors except an inverse relationship with the expression of the estrogen receptor (p < 0.05). Whereas EGF-R expression demonstrated prognostic significance in univariate analysis, this could not be confirmed by multivariate analysis. Immunohistochemical determination of EGF-R represents a reliable and simple method to obtain more data about the biological behavior of malignant breast disease with increasing impact on therapeutic procedures.

Aged↗
PubMedDate not supplied

Evaluation of the success of hemodilution therapy for fetal growth retardation by Doppler sonography.

The aim of our study was to evaluate the success of a hemodilution therapy in patients with intrauterine growth retardation (IUGR) using Doppler sonography. Therefore, 22 patients with IUGR were subjected to hemodilution therapy using infusions of 500 ml hydroxyethylstarch in combination with 500 ml Ringer solution on 14 successive days. The 22 patients were divided into two groups on the basis of the actual birth weight, whereas 13 patients gave birth to an eutrophic infant (AGA group) while 9 infants remained dystrophic (SGA group). The following parameters were determined: hematocrit, prolongation of gestation, pulsatility and resistance index of the umbilical artery, the fetal aorta, the uterine arteries and the middle cerebral artery as well as the fetal outcome. Although the hematocrit decreases in both groups were almost identical, the Doppler sonographic examinations in the AGA group revealed in all cases more favorable improvements in perfusion under therapy in comparison with the SGA group. Considering the fetal aorta we could determine a worsening of perfusion in the SGA group. In the course of our investigations we have found that hemodilution therapy with hydroxyethylstarch represents a promising approach to counteract retarded fetal growth. Doppler sonography progress monitoring appears to be highly suitable for evaluating the response to therapy, especially since it can be assumed that the absence of an improvement in flow indicates only a slight advantage for the child.

Adult↗
PubMedDate not supplied

[Induced labor with prostaglandins in birth weight below 2,500 g].

In a multicenter study the deliveries of 127 newborn infants with a birth weight less than 2500 grams were evaluated after induction of labour using prostaglandins, among them 90 infants with a birth weight below the 10. percentile in relation to the gestational age. The control group were 1566 deliveries of newborns with normal weight, delivered at term after induction with prostaglandins. The rate of vaginal deliveries was 67.6% in the group of newborns weighing less than 2500 grams and 84.1% in the control group. The rate of acidotic newborns (pH < 7.20) was remarkably higher in newborns below 2500 grams (12.6%), especially in the subgroup of growth retarded newborns (16.7%), when compared to the control group (9.5%). In primaiparae with fetal growth retardation and low Bishop score the induction of labour with prostaglandins resulted in an insufficient progress of labour. In this subgroup the rate of cesarean deliveries was 83.3%. Induction of labour was substantially more successful after premature rupture of membranes. The most favourable results were achieved in multiparae after premature rupture of membranes which resulted in vaginal deliveries in 94.5% of cases independent of gestational age.

Administration, Intravaginal↗
PubMedDate not supplied

[Treatment of hypertensive diseases in pregnancy--general recommendations and long-term oral therapy].

Hypertensive disorders are among the most common causes of maternal and perinatal mortality. Mild and uncomplicated chronic hypertension has a better prognosis than preeclampsia. The primary aims of therapy are to prevent cerebrovascular complications and to avoid the progression of chronic hypertension into superimposed preeclampsia with worse prognosis. In mild courses of the disease bedrest, whether at home or in the hospital, is commonly recommended. A special diet is not required neither for prevention nor for therapy. This also applies for the use of aspirin. Calcium supplementation during pregnancy seems to be effective in reducing the risk of hypertension and to a smaller extent of preeclampsia. Diuretic therapy is only indicated in exceptional cases. Antihypertensive drugs are recommended, if a sustained blood pressure of diastolic > or = 110 mmHg is recorded, in cases of superimposed preeclampsia even if the diastolic blood pressure is > or = 100 (> or = 90) mmHg. alpha-Methyl-dopa is the initial drug of choice for oral antihypertensive therapy. Neither short-term effects on the fetus or neonate nor long-term effects during infancy have been reported after long-term use of alpha-methyl-dopa in pregnancy. The oral application of beta-adrenergic-antagonist drugs is well-tolerated, but should be avoided in cases of severe fetal growth retardation. Dihydralazine treatment is not suitable for oral therapy, since its medication is associated with maternal side effects such as headache and tachycardia. Administration of drugs that inhibit angiotensin-converting enzyme during pregnancy is contra-indicated. Calcium-channel-blocking drugs are frequently used in the USA and in the UK as "second-line" antihypertensive medication, however there is little experience with the long-term administration of these drugs to pregnant women with hypertension. The indication for hospitalization are of particular clinical importance, since a delay in admission associated with maternal complications may lead to juridical troubles. The antihypertensive treatment is only a symptomatic therapy; the obstetrician must be aware that delivery is the ultimate cure of hypertensive disorders in pregnancy. In women with mild chronic hypertension or mild preeclampsia antihypertensive therapy is unlikely to be beneficial regarding the perinatal results, while in severe forms drug therapy is mandatory to avoid life-threatening maternal complications.

Antihypertensive Agents↗
PubMedDate not supplied

[Appearance of inflammatory cytokines interleukin-1 beta and interleukin-6 in amniotic fluid during labor and in intrauterine pathogen colonization].

Subclinical intrauterine infections have been proposed to be one of the leading causes of preterm labor. The determination of inflammatory cytokines IL-1 beta and IL-6 in the amniotic fluid may be useful to identify women who have infection-associated preterm labor. Amniotic fluid was collected from 99 women during amniocentesis, during cesarean section or at the time of amniotomy using sterile technique. IL-1 beta and IL-6 were determined by a specific ELISA. Fluid of each sample was cultured for aerobic and anaerobic bacteria and for Mycoplasma hominis and Ureaplasma urealyticum. Different populations were identified according to the criteria "gestational age", "active labor", "positive amniotic fluid cultures". Interleukin-6 was detectable in all samples of amniotic fluid. The second-trimester (weeks 14-27) amniotic fluid concentration of IL-6 (18-2270 pg/ml) was higher than in the third trimester (weeks 28-42, 4-329 pg/ml). The difference was significant. Women in active labor had higher levels of IL-6 in their amniotic fluid than women not in labor (p < 0.01). There is no significant difference between women with preterm labor and delivery (weeks 28-37, 597-8670 pg/ml) and with term labor and delivery (weeks 38-42, 24-8300 pg/ml). Only culture negative samples were included in this population. Interleukin-1 beta was not detectable in the majority (90%) of these samples. 30% of the women in labor had positive amniotic fluid cultures. The IL-6 concentration of this population was not elevated in comparison to women in labor with negative cultures. Interleukin-1 beta was present in high concentrations (5-1100 pg/ml) in all fluid samples with detectable bacteria. Our data suggest that IL-1 beta may indicate subclinical uterine infection. IL-6 is elevated in all fluid samples of women in active labor.

Amniocentesis↗
PubMedDate not supplied

[Sepsis and SIRS (systemic inflammatory response syndrome) in the puerperium--pathogenesis and clinical management].

PURPOSE: We report about 5 cases of "puerperal sepsis" to elucidate the clinical significance and resulting therapeutic management of Sepsis, SIRS (Systemic inflammatory response syndrome) and MODS (Multiple organ dysfunction syndrome), whose definitions were introduced at the Consensus Conference of the American College of Chest Physicians/Society of Critical Care Medicine in 1992. RESULTS: All patients had documented endomyometritis, 3 of them in combination with ovarian vein thrombosis. None of the patients responded adequately to conservative treatment with antibiotics and intravenously applied Heparin. After 12 to 72 hours, because of clinical deterioration, all women underwent laparotomy with hysterectomy combined with an ovarectomy in 3 cases. Although the inflammatory "septic" source was removed by the surgical intervention, the clinical condition of 3 of the patients further deteriorated; they were suffering from SIRS, and 2 developed MODS. Symptoms of MODS were DIC, hypotension, kidney failure and encephalopathy. CONCLUSIONS: Our results support the theory that infection or trauma may initiate an endogenous inflammatory response which could progress to MODS even after removal of the initial source. Our findings, however, do not support the view that septic endomyometritis and postpartum ovarian vein thrombosis should be treated nonsurgically, because the clinical course in our patients was less complicated the earlier the surgical intervention was initiated.

Adult↗
PubMedDate not supplied

[Sirenomelia--prenatal diagnosis and clinical consequences of a rare abnormality].

Sirenomelia or the mermaid syndrome is a rare birth defect, often combined with severe malformations of the urogenital system and the lower gastrointestinal tract. The incidence is about one case in 60,000. Ultrasound can be very important in early detection of this deformity. Because of the high incidence of oligohydramnios amnioninfusion could be helpful. Also a magnetic resonance radiographia in the prenatal period could be performed. We report three cases of sirenomelia and in addition the literature is reviewed and discussed.

Abnormalities, Multiple↗
PubMedDate not supplied

[Cytokine concentrations and expression of adhesion molecules in the lower uterine segment during parturition at term: relation to cervical dilatation and duration of labor].

OBJECTIVE: To determine the concentrations of tumor necrosis factor (TNF)alpha, interleukin (IL)beta, IL-6 and IL-8 and the expression of endothelial leukocyte adhesion molecule-1 (ELAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in the lower uterine segment during parturition at term and to investigate correlations with the stage of cervical dilatation and with the duration of labor. PATIENTS AND METHODS: Biopsy specimens were taken from the lower uterine segment of 59 women undergoing non-elective cesarean sectin at term at different stages of cervical dilatation (< 2 cm, n = 17; 2-3 cm, n = 12; 4-6 cm, n = 13; > 6 cm, n = 17) after varying length of the time in labor (1-6 h, n = 18; > 6-12 h, n = 16; > 12-24 h, n = 15; > 24 h, n = 10). The concentrations of TNF alpha, IL-1 beta, IL-6 and IL-8 in protein extracts of these specimens were determined by enzyme linked immunosorbent assays and the expression of ELAM-1 and VCAM-1 was studied by immunohistochemistry. Staining was considered negative if < 5% of the endothelial cells were stained and positive if > or = 5% were stained. RESULTS: At < 2 cm dilated cervix the median concentrations of TNF alpha, IL-1 beta, IL-6 and IL-8 were 8.0 pg/mg total protein (TP), 1.3 pg/mg TP, 12.6 pg/mg TP and 17.2 pg/mg TP, respectively. At 4-6 cm dilatation the median concentrations were increased (TNF alpha: 22.2 pg/mg TP [P = 0.05], IL-1 beta: 22.2 pg/mg TP [P < 0.05], IL-6: 1226 pg/mg TP [P < 0.05], IL-8: 2081 mg/mg TP [P < 0.05]). At > 6 cm dilatation no further increase was observed. The expression of ELAM-1 and VCAM-1 was significantly greater at > 6 cm dilatation than < 2 cm dilatation (P < 0.001 and 0.05, respectively). With increasing duration of labor, the concentrations of IL-1 beta, IL-6 and IL-8 (but not of TNF alpha) increased and were significantly higher at > 6 cm dilatation than at < 2 cm (P < 0.05). Expression of ELAM-1 and VCAM-1 did not vary with duration of labor. CONCLUSIONS: These first investigations of cytokines and cell adhesion molecules in the lower uterine segment at both different stages of cervical dilatation and different duration of labor support the decisive role of cytokines for normal cervical dilatation. Local changes in the lower uterine segment independent from the effects of labor (e.g. increase of endothelial adhesivity) seem to be of special importance in this process.

Cell Adhesion Molecules↗