H. Salzer

Prognostic factors related to recurrent endometrial carcinoma following initial surgery

Site of recurrence and histological type are significant prognostic factors for survival in recurrent endometrial carcinoma.

C-REACTIVE PROTEIN: AN EARLY MARKER FOR NEONATAL BACTERIAL INFECTION DUE TO PROLONGED RUPTURE OF AMNIOTIC MEMBRANES AND/OR AMNIONITIS

The C‐reactive protein (CRP) concentration was determined in 25 infants whose mothers had presented with prolonged rupture of amniotic membranes (PROM) and/or amnionitis. CRP was positive (i.e ≥ 6 mg/1) within the first 6 hrs of life in 10 and negative in 15 infants. Clinically, all infants with positive CRP developed symptoms suggesting bacterial infection and both the absolute immature neutrophil counts as well as the ratio immature/total neutrophils were significantly higher in them on day 2 of life than in infants with negative CRP. Blood cultures were only positive in infants with positive CRP. Thus CRP can be regarded as an early marker for neonatal bacterial infection due to PROM and/or amnionitis.

Goserelin a GnRH‐analogue as third‐line therapy of refractory epithelial ovarian cancer

Between October 1988 and March 1991, 23 ovarian cancer patients with progressive disease whilst receiving second- or third-line polychemotherapy received subcutaneously 3.6 mg Goserelin, a GnRH analogue, at monthly intervals until further tumor progression. Four patients (17.4%) achieved partial response, 7 patients (30.4%) had stable disease and 12 patients (52.2%) showed further tumor progression. Median time to tumor progression was 8.5, 5.3 and 2.1 months, respectively (Mantel test, P = 0.0003). Ten out of 11 patients who showed partial response or no change had grade 2 or grade 3 tumors. We conclude that Goserelin shows evidence of antitumor activity also in grade 2 and grade 3 ovarian carcinoma. It offers a therapeutic alternative to a group of patients, in whom we usually terminate cytotoxic treatment.

Antenatal betamethasone-dose-effects on fetal rat lung morphology and surfactant.

Pregnant rats received betamethasone 0.02, 0.05, 0.10, or 0.20 mg/kg body weight/day or saline (controls) for three days before delivery of fetuses at day 19 of gestation. Dose related effects on morphology, dipalmitoyl phosphatidylcholine content, and phosphatidylcholine species composition of the fetal lungs were evaluated. Injection of 0.02 and 0.05 mg/kg body weight betamethasone resulted in cellular differentiation of some cells, but the increase in dipalmitoyl phosphatidylcholine content was not significant. Dosages of either 0.10 or 0.20 mg/kg body weight resulted in markedly accelerated organ differentiation, complete cytodifferentiation of type II cells, and markedly increased numbers of lamellar bodies per alveolar type II cell. Compared to the controls, maternal administration of 0.10 or 0.20 mg/kg betamethasone caused significant increases of both fetal lung dipalmitoyl phosphatidylcholine content, and the fraction of dipalmitoyl phosphatidylcholine of total phosphatidylcholine. None of the parameters differed between the groups that were treated with 0.10 or 0.20 mg/kg body weight betamethasone respectively. Diminution of lung DNA content was significant after treatment with betamethasone in doses of 0.05, 0.10, and 0.20 mg/kg body weight. The results of the present study suggest that maternal treatment with lower doses than those in common usage may be successful in prevention of respiratory distress syndrome, and that higher dosages do not confer any additional advantage.

Relationship between Carnitine, Fatty Acids and Insulin Resistance

Increased plasma free fatty acid (FFA) levels are a feature of insulin resistance and type 2 diabetes. The aim of the present study was to assess the effect of L-carnitine supplementation on plasma lipids and the expression of enzymes in peripheral mononucleated cells (PMNC) involved in the regulation of fatty acid and glucose oxidation. L-Carnitine supplementation of 2 g/day resulted in a significant decrease in plasma FFA and in a less pronounced diminution of the plasma triacylglycerols. In addition, a concomitant increase in the relative mRNA abundances of carnitine acyltransferases (5- to 10-fold) and of the carnitine carrier OCTN2 (12-fold) in PMNC of pregnant women was found. The results of the present study provide evidence that L-carnitine supplementation in pregnancy (2 g/day) avoids a striking increase in plasma FFA, which are thought to be the main cause of insulin resistance and consequently gestational diabetes mellitus.

Non-Enzymatic Glycation of Fetal Tissue in Diabetic Pregnancy.: Estimation of the Glucitollysine Content of Umbilical Cord Extracts

ABSTRACT. Non‐enzymatic glycation of fetal tissue was studied by determining the glucitollysine content of umbilical cord extracts from twelve infants of diabetic mothers and fourteen infants of healthy, non‐diabetic women (controls). The single, glycated amino‐acid glycitollysine, which reflects the extent of glycation processes in biological samples, was measured by a standard amino acid ion exchange chromatography followed by reverse phase high pressure liquid chromatography. Infants of diabetic mothers had significantly higher cord glucitollysine levels than infants of control mothers (14.3+4.6 vs. 5.5+2.1 ng/mg dry tissue; M+SD, p<0.001). Moreover, five infants of diabetic mothers with congenital anomalies had strikingly high glucitollysine levels, higher than the mean +4 SD of the controls. We conclude, that non‐enzymatic glycation of fetal tissue does occur as a result of an in utero exposure to cumulative glycemia. Major congenital anomalies in diabetic pregnancies are associated with a greater extent of non‐enzymatic glycation of umbilical cord tissue.

Femara®: der neue Aromatasehemmer

Ziel aller hormonellen Behandlungsmassnahmen ist die Ausschaltung der östrogenbedingten Wachstumsstimulation von Tumorzellen. Dies ist durch Suppression der Östrogenproduktion, durch Medikamente, die die Östrogenrezeptoren besetzen, ohne östrogene Wirkung auszuüben, und durch Reduktion der zellulären Östrogenrezeptoren möglich. Aromatasehemmer unterdrücken die zelluläre Umwandlung von Androstendion zu Östron. Androstendion wird in der Nebennierenrinde gebildet und kann in den peripheren Geweben, auch im Tumorgewebe, zu Östron umgewandelt werden. Dieser Stoffwechselweg stellt die Hauptquelle der Östrogenproduktion postmenopausaler Patientinnen dar. Die Gruppe der Aromatasehemmer hat während der letzten Jahre einen festen Platz in den Therapiekonzepten für Patientinnen mit hormonabhängigen, metastasierenden Mammakarzinomen einnehmen können. Neue Aromatasehemmer wie Letrozol oder Anastrozol lassen die Steroidsynthese in der Nebenniere weitgehend unbeeinflusst.

Einfluss einer adjuvanten Hormontherapie auf den Gesamtorganismus der Frau: Nutzen versus potentieller Schaden

Not only do patients suffering from hormone receptor-positive tumors of the mammary gland show an increased survival rate, but patients with endometrial as well as ovarian cancer also benefit from hormone replacement therapy. On the one hand, hormonal treatment as well as any other medical treatment influences the tumor, and on the other hand it influences the whole body, which sometimes leads to unfavorable events (increased rate of endometrial cancers during tamoxifen therapy vs. increase of bone density in postmenopausal women). Therefore, hormonal cancer treatment is often suspect. As unfavorable events are rare, and since the benefit is convincing, doctors have to inform women about all the pros and cons of this treatment option, which leads to well-informed and cooperative patients.

Überlebensprognose bei Ovarialkarzinomen in den Figo-Stadien III und IV: 1980–1985 versus 1986–1993

Wir fuhrten eine retrospektive Untersuchung der Uberlebensprognose von 638 Patientinnen mit Ovarialkarzinom in den Figo-Stadien III und IV durch. Eingeschlossen wurden die Zeitraume 1980–1985 versus 1We examined the survival prognosis of 638 patients who had ovarian carcinoma Figo stages III and IV. We considered two separate time periods, 1980-1985 versus 1986-1993, including the size of the postoperative residual tumor, polychemotherapy with and without platinum, histological grading 1 versus 2 and 3, Figo stage III versus IV, and ascites present versus no ascites. Since 1986, 96% of the patients received platinum-containing polychemotherapy at a dosage of > or = 75 mg/m2, whereas between 1980 and 1985, only 76% of these patients received platinum-containing polychemotherapy at a dosage of 50 mg/m2, and 24% of the patients received polychemotherapy without platinum. The size of residual tumor masses and also the time period of treatment had an independent influence on survival prognosis. Patients treated from 1980 to 1985 had a relative risk to die which was 1.44 times higher than for the patients who were studied from 1986 to 1993.

Prospective Randomized Trial of Sequential Alternating Chemotherapy in Advanced Ovarian Carcinoma

Background: The aim of this multicentric study was to compare the therapeutic efficacy of a sequentially alternating drug regimen consisting of adriamycin-cisplatinum (AP), vincristine-cyclophosphamid