H. Enzelsberger

Radioimmunoscintigraphy Using Monoclonal Antibodies before Second-Look Surgery in Patients Suffering from Ovarian Cancer

19 patients with a known history of ovarian cancer were investigated by radioimmunoscintigraphy (RIS) to look for recurrent disease a few days before second-look surgery. The tumor-associated monoclonal antibody HMFG-2 (400 micrograms/patient) was injected intravenously after labeling with radioactive 123I (0.5-2.2 mCi/patient). Scans were reviewed for activity accumulations due to uptake of the tumor-associated antibody by tumor sites. In 15 out of the 19 cases the scan results correlated with the intraoperative findings. There were 2 false-positive and 2 false-negative scans, the latter in patients with subclinical disease. The smallest lesion detected by radioimmunoscintigraphy had a diameter of 1.5 cm. In 3 patients, tumor sites were identified that had been missed by all other routinely performed methods of investigation including transmission computed tomography. These data indicate that RIS is of considerable clinical value in the early detection and localization of recurrent ovarian cancer and may, therefore, improve the management of these patients.

Hormone replacement therapy and its influence on AT-III activity in climacteric women.

50-85% of women report several complaints during the climacteric period and menopause. Complaints may include flush, sleep disturbances of depressions and seriously impair the patients well-being. We were interested to determine whether estrogen in various modes of application (oral or transdermal) can alter antithrombin III activity. The menopausal status was investigated in all patients (Ez levels <30 pg/ml, FSH levels >40 mu/ml). 175 patients received conjugated estrogens at 0.625 mg (group I), 82 patients were given conjugated estrogens at 1.25 mg (group II), and 107 patients were treated by transdermal estrogen application (TTS 50 mcg) (group Ill). All replacement schemes contained additional progestin (progestin derivatives [1]. A hormone status as well as clinical antithrombin III determination were performed before therapy and 12 months after the beginning of estrogen replacement. Antithrombin III determination was performed with the AT-III color test developed by Mannheim-Boehringer [2]. The statistical differences between the investigated parameters werde determined by way of the t-test of paired random samples. A decrease of antithrombin III activity during treatment is an indication of a shift of hemostasis towards coagulation.

Urethrovesikale Morphologie bei kontinenten Frauen in Spinalanästhesie

Fragestellung: Wie wirkt sich eine neuromuskulare Blockade des Beckenbodens bei kontinenten Frauen auf klinische, urodynamische und morphologische Befunde des unteren Harntraktes aus? Methoden: In einer prospektiven Studie wurden 14 kontinente Frauen ohne Deszensus unmittelbar vor und wahrend Spinalanasthesie klinisch urodynamisch und sonographisch untersucht. Ergebnisse: Wahrend der Spinalanasthesie zeigte sich gegenuber der praoperativen Evaluierung eine signifikant tiefere Blasenhalsposition und bei 4 von 7 Para (0 von 7 Nullipara) ein positiver klinischer Stresstest (p = 0,003). Schlussfolgerungen: Diese Ergebnisse unterstreichen die Bedeutung neuromuskularer Faktoren fur die Atiologie von Beckenbodeninsuffizienz und Stressharninkontinenz.

[The prognostic effect of scintigraphy-guided lymphadenectomy in therapy of stage Ib cervix carcinoma].

In a retrospective study the survival rates of 161 patients with stage Ib cervical cancer after radical operation (Latzko, Wertheim-Meigs) including complete or incomplete pelvine lymphadenectomy were compared. To increase radicality of lymphadenectomy, preoperative targeting of pelvic lymph nodes was done in all the patients using 99mTc-Sb2S3 radiocolloid. Intraoperatively, a gamma-camera being integral part of an operating table allowed delineation and scintigraphy-guided resection of pelvic lymph nodes. Dependent on the evidence of remaining pelvine foci of radioactivity at the end of the operation, lymphadenectomy was assessed as complete or incomplete. Mean observation time of completely lymphadenectomised patients (n = 117,72.67%) were 80 months (5-169 months) and 42 months (1-149 months) of the incompletely lymphadenectomised patients (n = 44,27.33%). In 28 (23.93%) completely lymphadenectomised patients against only 5 (11.36%) patients with incomplete lymphadenectomy, lymph node metastases were proved histologically. Five year-survival rate of completely lymphadenectomised patients was 85.47% and 88.64% of incompletely lymphadenectomised patients (not significant, Mantel-Test). Also, selective comparison of lymph node-positive patients did not suggest a divergent trend indicated by 13 (46.43%) deaths of completely and 3 (60.0%) deaths of the incompletely lymphadenectomised patients after an observation of five years. The technique of scintigraphy-guided pelvic lymphadenectomy using 99mTc-Sb2S3 radiocolloid cannot be expected to improve prognosis of patients with cervical cancer stage Ib.

Arthropathia climacterica — zur Ätiologie und Epidemiologie

Unter den zahlreichen Symptomen des klimakterischen Syndroms stellen die Gelenkbeschwerden — vor allem der kleinen Gelenke — ein Symptom dar, welches sehr haufig fur die betroffene Frau bzw. den behandelnden Arzt ein groses Problem darstellt. Unsere Arbeitsgruppe hat sich im Rahmen dieser Arbeit vor allem die Frage gestellt, in welchem Prozentsatz die „klimakterischen Gelenkschmerzen“ auftreten und mit welcher Effizienz bzw. in welchem Zeitraum durch eine entsprechende Hormonsubstitutionstherapie eine Besserung bzw. eine Heilung erzielt werden kann.