Ch. Kainz

Treatment of skin ageing symptoms in perimenopausal females with estrogen compounds. A pilot study

A wide range of somatic symptoms of the perimenopausal female is due to the decrease of estrogen at that age. Minor attention has been paid hitherto to the involvement of estrogens in female skin ageing symptoms. In our study, the ageing skin of the face of perimenopausal females was treated with a 0.3% estriol cream (8 patients) or with a 0.01% estradiol cream (10 patients) for 6 months. Dermatologic follow-up was performed monthly. At each follow-up venous blood for radioimmuno assay determination of prolactin (PRL), follicle stimulating hormone (FSH) and estradiol (E2) was sampled. In addition, prior to and after 3 and 6 months of treatment, gynecological examinations for climacteric symptoms, mammary and colposcopic investigations and vaginal smears for cytology were performed. Both treatment groups showed improvement of the various skin ageing symptoms at the end of treatment. The effects of the group treated with topical estriol were slightly superior with regard to their extent and onset. No hormonal side effects were noted either clinically or by hormone monitoring. According to these preliminary results, local estrogen treatment appears to be a promising new approach for the treatment of skin ageing in perimenopausal females. However, for minimizing the risk of systemic hormonal side effects, concentrations and size of application field should be limited.

Prognostic value of immunohistochemically detected CD44 isoforms CD44v5, CD44v6 and CD44v7–8 in human breast cancer

We investigated the expression of CD44 isoforms containing variant exons v5, v6 and v7-8 in 115 human breast cancer specimens by means of immunohistochemistry. CD44 isoforms CD44v5, CD44v6 and CD44v7-8 were detected in 56% (n = 64), 24% (n = 28) and 15% (n = 17), respectively. In 36 specimens of axillary lymph node metastasis, expression of CD44v5, CD44v6 and CD44v7-8 was found in 94% (n = 34), 92% (n = 33) and 89% (n = 32), respectively. Five year survival rates with or without CD44v5 and CD44v6 expression were 71% versus 86% (log-rank test, P = 0.02) and 62% versus 81% (log-rank test, P = 0.001), respectively. For disease-free survival, expression of CD44v5, CD44v6 and CD44v7-8 showed a prognostic impact (log-rank test, P = 0.004, P = 0.0001 and P = 0.0001, respectively). However, multivariate analysis revealed that all investigated CD44 isoforms failed to be independent predictors of the patients outcome.

Serum Evaluation of Basic Fibroblast Growth-Factor in Cervical-Cancer Patients

We present the data of 105 serum samples from 20 patients suffering from cervical cancer. Mean serum levels of basic fibroblast growth factor (bFGF) in patients with or without tumor present were 31.3 +/- 32.1 (minimum 0, maximum 156.7) pg/ml and 4.8 +/- 6.8 (minimum 0, maximum 29.6) pg/ml, respectively (P = 0.0001). bFGF reached a sensitivity of 65.7% at a specificity of 91.5% when applying a cut-off level of 15 pg/ml. Four patients relapsed after complete remission. A continuous increase of bFGF serum levels before the clinical detection of relapse (lead time) was seen in two cases with a mean lead time of 4 months. Preoperative serum levels were not of prognostic value and showed no correlation with pelvic lymph node metastasis. These preliminary results indicate that in cervical cancer patients soluble bFGF may be useful in early detection of primary tumors, recurrences and monitoring of therapy.

Prognostic value of immunohistochemically detected HER-2/neu oncoprotein in endometrial cancer

HER-2/neu (c-erbB-2) oncoprotein is a transmembrane glycoprotein and may function as a growth factor receptor being involved in the regulation of cell growth and cell transformation. We performed an analysis of 100 patients with endometrial cancer stage FIGO I to IV using an immunoperoxidase technique on formalin-fixed, paraffin-embedded tissue samples in order to determine HER-2/neu oncoprotein expression. HER-2/neu oncoprotein was expressed in the tumors of 21 patients (21%). Clinical stage, histologic stage, histologic grade and death of invasion did not correlate with HER-2/neu oncoprotein expression. We found HER-2/neu oncoprotein in all clinical stages and therefore it does not seem to be a late event in the natural history of endometrial cancer. HER-2/neu oncoprotein expression was associated with poor overall survival (log-rank P-value 0.04).

Influence of acupuncture on maternal serum levels of interleukin-8, prostaglandin f2alpha, and beta-endorphin: a matched pair study

Objective To measure the serum levels of interleukin (IL)-8, prostaglandin (PG) F2α and β-endorphin in parturients with acupuncture treatment and in controls to clarify the effect of acupuncture and duration of labor on the serum levels of substances active in cervical ripening and dilatation. Methods A matched pair study was performed involving 80 women with and without prenatal acupuncture treatment, matched for age and parity. Serum levels of IL-8, PGF2α, and β-endorphin were measured in serum samples taken after delivery by use of enzyme-linked immunosorbent assay, enzyme immunoassay, and immunoradiometric assay, respectively. Results The mean difference in total duration of labor between matched pairs with and without acupuncture was-136.5 minutes (95% confidence interval [CI] 191.1 minutes,-81.9 minutes; paired t test, P < .001). The mean difference of the duration of the first and second stages of labor between matched pairs with and without acupuncture was-138.8 minutes (95% CI 188.6,-89.0 minutes; paired t test, P < .001) and 2.3 minutes (95% CI 15.5, 20.1 minutes; paired t test, P = 55 .8), respectively. The geometric means of ratios of IL-8, PGF2α, and β-endorphin between matched pairs in women with and without acupuncture showed no statistically significant differences. Serum levels of IL-8, PGF2α, and β-endorphin were not significantly correlated with the duration of the first and second stages of labor. Conclusion Prenatal acupuncture treatment significantly reduces the duration of labor and may be a valuable tool in prenatal preparation. Serum levels of IL-8, PGF2α and β-endorphin are not significantly influenced by acupuncture and are therefore not likely to mediate acupuncture-related effects during labor.

AN ANALYSIS OF THE PREDICTION OF CEPHALOPELVIC DISPROPORTION

SummarySince cephalopelvic disproportion inevitably leads to cesarean section it seems to be mandatory to identify patients with an absolute discrepancy between the size of the fetus and the birth canal in order to avoid unnecessary trials of labour. In a case control study, comparing a group of patients who delivered by cesarean section because of cephalopelvic disproportion with an age matched control group, routinely assessed pelvic measurements and measurements of the newborn were correlated to cephalopelvic disproportion. Multivariate linear regression was applied to each group to determine, which of the maternal and fetal factors had the strongest influence on the mode of delivery. In the study group external conjugate showed the strongest positive relation to maternal body height (P<0.01), the biparietal diameter of the newborn was negatively correlated (P<0.01). None of the analyzed variables reached statistical significance in the control group. Differences between the two groups were marginal, thus providing no safe basis for decision making even in a population at high risk for developing cephalopelvic disproportion.

CD44-Splice-Varianten als Prognosefaktoren beim invasiven Zervixkarzinom

Fragestellung: Eine aberrante Expression von spezifischen Isoformen (Splice-Varianten) des Adhasionsmolekuls CD44 wurde in verschiedenen malignen Tumoren des Menschen nachgewiesen. Wir wollten abklare

Menstrual phase and breast cancer surgery: influence on clinical outcome or pitfall of statistical analysis?

The influence of menstrual status at the time of surgery on the prognosis of women suffering from breast cancer is still discussed controversially. In our patient collective, including 149 patients, we obtained statistically significant results for six different time intervals, indicating that patients who underwent surgery between 11 and 22 days after the last menstrual period (LMP) have a poorer outcome. Focusing on the effect of statistical data evaluation strategy we designed a simulation study to evaluate the amount of type I error (error of a false positive test result) in a multiple testing situation involving a cyclical covariate. Accordingly, we corrected the minimum P-values for the occurring type I error rates. After that correction all six previously significant P-values failed to achieve statistical significance. The impact of different statistical data evaluation strategies in a multiple testing situation is discussed.

Survey of computerized obstetric information systems in Austria

SummaryThe aim of this study was to evaluate obstetric electronic data processing (EDP) in Austria and to analyse its problems, advantages and acceptance in a single big obstetric department. We sent questionnaires to every obstetric department in the country. The overall response rate was 77% (73 departments). Only 24 (33%) were using computer aided documentation, but these covered 63% of deliveries in Austria. The proportionate times spent on documentation were 57% for physicians and 43% for midwives, with physicians playing a bigger role in larger departments using electronic documentation. Sixty-five percent of physicians and 31% of midwives readily accepted computerization. We also studied an obstetric department with over 3000 births per year. Twenty-five percent of the medical staff did not believe that computerization saved time, although they appreciated its value to administration and for producing printouts. Advantages in completeness (92%) and accuracy (76%) were recognized. After 6 months use acceptance of EDP documentation improved significantly.

Pregnancy complicated by malignant melanoma

Although several studies exist about malignant melanoma during the active reproductive years of women, it remains unclear whether the effect of pregnancy on the course of the disease is of considerable concern. Some investigators suggested that malignant melanomas are particularly lethal when they arise during pregnancy. Others suggested that the adverse effect of pregnancy is only evident in metastatic disease whereas some investigators implicated the enhancing effect of exogenous hormones on the development of malignant melanomas ( I , 2, 3). Several host conditions are altered during pregnancy, which may affect the pathogenesis of melanoma, including anatomic, hormonal and immunologic factors.