G. Tatra

Complications of vaginal hysterectomy under "difficult" circumstances.

SummaryVaginal hysterectomy is less invasive than hysterectomy performed via the abdominal approach. The vaginal approach may be made difficult by prior conisation, a need to remove the adnexae or marked uterine enlargement requiring morcellement. In this retrospective study we have investigated the impact of these factors on the incidence of complications in 1912 patients subject to vaginal hysterectomy. We have studied the incidence of intraoperative hemorrhage, bladder damage, hemorrhage up to 48 h after surgery, hemorrhage up to 14 days after surgery, vault abscesses or collections and pelvic peritonitis. In patients with prior morcellement, intraoperative hemorrhage was significantly more frequent. All other complications were not significantly increased by the intraoperative difficulties specified above. Thus even “difficult” vaginal hysterectomy would seem to carry low morbidity.

Relationship between plasma levels of components of the fibrinolytic system and acute-phase reactants in patients with uterine malignancies.

Abstract. Plasma samples from 17 patients with endo‐metrial cancer and from 52 patients with cervical carcinoma were determined with respect to their levels of components of the fibrinolytic system (tissue‐type plasminogen activator antigen, urokinase‐type plasmi‐nogen activator antigen, plasminogen activator inhibitor activity) and related to the observed alterations of three acute‐phase reactants (C‐reactive protein, coeru‐loplasmin, α‐1‐antitrypsin). As shown previously, uterine malignancies, especially at later stages, exhibited significant increases in plasma levels of urokinase‐type plasminogen activator antigen as compared to an age‐matched control group. In contrast, tissue‐type plasminogen activator antigen and plasminogen activator inhibitor activity remained unchanged. Determination of the acute‐phase reactants revealed significant changes in the case of C‐reactive protein and coeruloplasmin in later tumour stages. However, the increase in urokinase‐type plasminogen activator antigen did not correlate with the increase of either C‐reactive protein or coeruloplasmin plasma level. These data indicate that the increase in plasma urokinase‐type plasminogen activator antigen in patients with uterine malignancies does not follow the pattern of common acute‐phase reactants, like C‐reactive protein or coeruloplasmin.

PREMALIGNANT AND MALIGNANT UTERINE CHANGES IN IMMUNOSUPPRESSED RENAL TRANSPLANT RECIPIENTS

Abstract. 29 female immunosuppressed renal transplant recipients were examined gynecologically. In 2 cases the epithelium of the portio was found to be dysplastic, while endometrial carcinoma was present in 1 patient. A review of the literature suggests that immunosuppressed patients are more likely to develop tumors than others. The authors stress the need for gynecological and cytological examinations at short intervals, to identify premalignant and early malignant uterine changes at a time at which these can readily be treated without discontinuation of the immunosuppressive therapy.

Oral contraceptives and human papillomavirus infection in cervical intraepithelial neoplasia

SummaryWe report about 142 patients from whom colposcopically directed cervical punch biopsies were taken which showed condylomatous lesions with or without cervical intraepithelial neoplasia (CIN). Fiftysix (39.4%) of these women used oral contraceptives (OC) for at least two years before examination. We used DNA in situ hybridization on all biopsies for detection of human papillomavirus (HPV)-DNA. Among OC users a significant trend towards higher HPV infection rates in high grade CIN (odds ratio 2.9,P<0.05) was found, whereas non-users of oral contraceptives had the highest HPV infection rate in condylomatous lesions without CIN (odds ratio 0.5,P<0.05). Thus in OC users HPV infection was about 24 times more likely in CIN III as in condyloma, whilest among non-users the trend was the other way round (7-fold likelyhood of HPV positivity in condyloma compared to CIN III). Other known risk factors for cervical carcinoma did not influence HPV infection rates in either group.

Diagnosis of cervical intraepithelial neoplasia and human papillomavirus infection: punch biopsy versus cervical smear

SummaryIn 102 patients referred to our colposcopy clinic because of one to three Papanicolaou smears indicating cervical intraepithelial neoplasia (CIN) and/or abnormal colposcopy, routine smears and colposcopically directed punch biopsies were taken simultaneously. For detection and typing of human papillomavirus (HPV)-DNA in situ hybridization was performed in all biopsies and in 46 of the cervical smears. In cases of dysplastic lesions the number of HPV 16/18 (40.5%) and 31/33 (42.9%) was markedly higher than HPV 6/11 (16.6%) infection rate. In cases where simultaneous in situ hybridization in biopsy specimen and cervical smears was performed 21.7% showed a HPV negative smear and a positive biopsy, in 6.5% the results were the other way round. In 34.9% of cases with CIN I and 9.5% of cases with CIN II verified by punch biopsy the cytological smear did not indicate dysplasia. Our data show that mild and moderate CIN lesions of the cervix as well as HPV infection are detected more frequently by a combination of cervical smear and colposcopically directed punch biopsy than by cervical smear alone.

Influence of delivery on plasminogen activator inhibitor activity

Plasminogen activators initiate the fibrinolytic system by conversion of the proenzyme plasminogen to the active fibrin degrading enzyme plasmin. Plasminogen activator inhibitors inhibit the effects of both plasminogen activators. Uncomplicated pregnancies are accompanied by hypercoagulability and an increased risk of thromboembolic disease. Thrombosis is rare in the first trimester and most events are noted in the last trimester. Therefore, we studied the fibrinolytic system at the end of pregnancy and in the puerperium. Plasma concentrations of urokinase plasminogen activator (u-PA/competitive radioimmunoassay), tissue type plasminogen activator (t-PA/sandwich ELISA) and plasminogen activator inhibitor (PAI/functional assay) were determined in 44 women (age: 24.3 +/- 4.3 years) with normal pregnancy near term. Plasma samples were collected before the onset of labour and 1, 2, 3, 4 and 5 days after delivery. Compared with an age-matched non pregnant control group (8.3 +/- 3.94 U/ml) significantly increased PAI activity (12.13 +/- 4.79 U/ml - p less than 0.005) was measured before delivery with a subsequent significant decrease (8.13 +/- 1.97 U/ml) to normal values on day 1 after delivery; plasma u-PA and t-PA antigen levels remained unchanged. Placental weight and birth weight had no influence on plasma levels of both plasminogen activators.

Quantitative immunologische Bestimmung der Antithrombin III-Konzentration bei normaler Schwangerschaft und post partum

SummarySerum antithrombin III levels in normal pregnancy after 13th week of gestation and post partum were determined by single radial immunodiffusion method.The mean values of levels of normal pregnancy were found between 14.76 and 18.42 mg/100 ml.The levels were decreased in comparison to non pregnant women. Mean values of levels were significantly decreased during gestation.ZusammenfassungDie bei der normalen Schwangerschaft gefundenen Mittelwerte von Antithrombin III im Serum liegen zwischen 14,76 und 18,42 mg/100 ml; damit lassen sie eine deutliche Erniedrigung gegenüber den Normwerten nichtschwangerer Frauen erkennen.Außerdem findet sich ein signifikantes Absinken der Werte von der 13. Woche bis zum Ende der Schwangerschaft.

Immunohistochemistry in pelvic nodes of patients with cervical cancer

During the years 1980I986 a total of I58 women with cervical carcinoma stage Ia to IIB underwent Wertheim-Meigs operation at the 2nd Department of Obstetrics and Gynaecology, University of Vienna Medical School. Obturdtor and iliac lymph nodes were resected in all patients. In 11 1 the lymph nodes were histologically free of tumour. Ten of the 1 1 1 women developed tumour recurrence during a follow-up period of at least 5 years; three of them had histological stage IB and seven had stage IIB carcinoma at primary surgery. All of the stage IIB patients had irradiation therapy after surgery. Histology revealed eight squamous cell carcinomas, one adenocarcinoma and one muco-epidermoid carcinoma. In nine tumours vascular involvement was detected (we did not distinguish between veins and lymphatics, because the differentiation between these small vascular channels is often uncertain). Inflammatory stromal reaction at the tumour invasion front was pronounced in two of the carcinomas, moderate in three and weak in five. Routine histological and immunohistochemical procedures included the examination of all dissected lymph nodes at two or three levels. The aim of our study was to assess the usefulness of immunohistochemistry for the detection of micrometastases in pelvic lymph nodes which had been judged negative by the pathologist.

Immunhistochemie in Beckenlymphknoten von Frauen mit operiertem Zervixkarzinom

Immunhistochemische Farbemethoden erhohen die Sensitivitat der Metastasenentdeckung wenn uberhaupt nur unwesentlich. Entscheidender ist die exakte Praparation der Lymphknoten durch den Pathologen in mehreren Schnittebenen.

Plasminogenaktivatoren in Granulosazellen und Fertilisierung menschlicher Eizellen

In Studien an Granulosazellen der Ratte konnten steigende Konzentrationen von Plasminogenaktivatoren zum Zeitpunkt der Ovulation nachgewiesen werden. Diese Ergebnisse weisen auf einen Zusammenhang zwischen dem Gehalt von Plasminogenaktivatoren in den Granulosazellen und der Ovulation hin [1, 3, 4].