Josef Haas

A common 936 C/T gene polymorphism of vascular endothelial growth factor is associated with decreased breast cancer risk

A common 936 C/T polymorphism in the gene for the vascular endothelial growth factor (VEGF) has been associated with VEGF plasma levels. In our case‐control study, we investigated the role of this polymorphism for breast cancer risk. VEGF genotype was determined in 500 women with breast cancer and 500 sex‐ and age‐matched healthy control subjects. Carriers of a 936T‐allele were more frequent among controls (29.4%) than among patients (17.6%; p = 0.000014). The odds ratio for carriers of a 936T‐allele for breast cancer was 0.51 (95% confidence interval 0.38–0.70). Additionally, VEGF plasma levels were determined in 21 nonsmoking post‐menopausal controls; carriers of a 936T allele had significantly lower levels (median 23 pg/ml; range 6–50 pg/ml) than noncarriers (37; 21–387; p = 0.034). We conclude that carriers of a VEGF 936T‐allele are at decreased risk for breast cancer, this, however, requiring further confirmation in a larger study.

Prognostic factors and operative treatment of stages IB to IIB cervical cancer

Between 1971 and 1985, a total of 325 cases of cervical cancer, Stages IB to IIB, in which operation was performed were evaluated with a view toward prognostic factors and survival rates. In radical abdominal operations, a complete resection of parametrial tissue was the goal. Extensive lymphadenectomy of the pelvis was performed. Operative specimens were processed by giant sections comprising cervix, lateral parametria, and vaginal cuff. Lymph nodes were cut by step-serial sections. Exact measurements of tumor sizes were done along with investigations of parametrium and lymph nodes. Tumors were classified according to a ratio of tumor size to size of cervix. Incidence of lymph node involvement increased with tumor size, reaching a maximum of 68.3% in the group with a ratio from 70% to 80%. Direct spread into the parametrium was rarely found, even in larger tumors occupying the entire cervix. parametrial lymph nodes were most often involved; these were scattered over the entire ligament. Five-year survival rates reached 88.1% in patients with no nodal involvement and 60.9% with nodal involvement. In the latter, the results depended on the number of nodal groups involved and the diameter of metastases. Parametrial involvement alone had no influence on healing rates, but when pelvic nodes were simultaneously involved, the results were less satisfactory. Survival rates based on tumor size differed only between the group with a ratio up to 20% and the large-tumor groups, with rates ranging from 97.5% to 70.9%. There was no statistical difference between Stages IB (31.1% positive nodes) and IIB (44.1% positive nodes) with regard to survival rates (82.2% and 76.9%, respectively).

Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study.

Objective: The purpose of the study was to investigate the long‐term treatment side effects on the quality of life (QoL) and sexual functioning of cervical cancer survivors undergoing different treatment regimens.

The importance of parametrial lymph nodes in the treatment of cervical cancer

This study aimed to determine the presence, distribution, and metastatic involvement of lymph nodes in the parametria of patients undergoing radical hysterectomy for cervical cancer. Parametrial nodes were present in the giant sections of 280 (78%) of 359 surgical specimens, and metastatically involved nodes were found in 63 (22.5%) of these 280. Both positive and negative nodes were distributed through the entire parametrium. The frequency of positive nodes was linearly associated with both the clinical stage and with the tumor volume. The recurrence rate was higher when the parametrial nodes were positive than when they were negative. Survival dropped when the parametrial nodes were positive, regardless of the clinical stage.

Magnetic resonance imaging in cervical cancer: A basis for objective classification

Conventional clinical staging of cervical cancer is subjective because it is based on palpatory findings and inadequate because it cannot assess the single most important prognostic factor--tumor size. To determine the exactitude of in vivo MRI measurements of tumor volume, 22 patients with invasive cervical cancer were studied before surgery. The volumes obtained by MRI correlated well (r = 0.983) with those obtained by histomorphometric analysis of the surgical specimens, but only weakly with clinical stage. MRI may provide a basis for precise classification of cervical cancer and for objective comparison of surgery and radiotherapy.

Risk factors and determinants of neurodevelopmental outcome in cystic periventricular leucomalacia

Abstract The aim of the study was to determine risk factors for the development of cystic periventricular leucomalacia (PVL) and to correlate ultrasound findings with neurodevelopmental outcome. By means of a retrospective case-control study (matched for gestational age, birth weight, sex, and year of birth) and a cohort analysis of all preterm infants with cystic PVL documented by ultrasound scans hospitalised at a local tertiary care centre between 1988 and 1998, 98 preterm infants with a gestational age ranging from 26 to 35 weeks were diagnosed as having cystic PVL. The mean day of diagnosis of periventricular echodensities was 3 ± 2 days (range 1–11 days), and of cystic PVL 21 ± 8 days (range 2–47 days). Of 79 infants (1988–1997) eligible for neurodevelopmental follow-up (91%), hemi-, di-, or tetraplegia was diagnosed in 61 (77%), normal mental outcome in 22 (28%), associated visual disorders in 41 (52%) and seizure disorders in 12 (15%) infants. Significant risk factors associated with the development of cystic PVL were premature rupture of membranes, chorioamnionitis, and hyperbilirubinaemia (odds ratios 4.665, 6.026, and 2.460 respectively). Subgroup analysis according to gestational age (26–28, 29–32, 33–35 weeks) revealed similar results despite spontaneous labour (26–28 weeks; odds ratio 4.808) and pre-eclampsia (33–35 weeks; odds ratio 3.517). Multiple pregnancy was associated with a twofold increased risk (odds ratio 2.075). The white matter damage probably accounted for the significantly higher prevalence of apnoeas (P < 0.001) and neonatal seizures (P < 0.001). Cysts located bilateral or parieto-occipital were associated with a higher risk of cerebral palsy (odds ratios 6.933 and 4.327 respectively). Solely anterior located cysts were associated with normal neurological outcome. Increasing size of the cysts was associated with increasing risk of cerebral palsy with a cut-off value of 10 mm (odds ratio 3.300 and above) and all infants with cysts of more than 20 mm diameter had cerebral palsy. Conclusion The high prevalence of premature rupture of the membranes and chorioamnionitis further supports the role of intra-uterine infection in the pathogenesis of periventricular leucomalacia. The overall prognosis of cystic periventricular leucomalacia is poor.

Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer

To determine the incidence and clinical import of lymphocysts after radical gynecologic surgery including lymphadenectomy, we reviewed the records of 173 patients with cervical cancer and 135 patients with ovarian cancer who were followed up by computed tomography. Lymphocysts were found in 35 (20%) and 43 (32%) of the patients, respectively. Patients with cervical cancer and positive lymph nodes had a significantly higher rate of lymphocyst formation than did those with negative nodes (29% versus 14%, respectively, p less than 0.02). Age, type of lymphadenectomy, volume of fluid furthered by postoperative drains, disease stage, and tumor histology were not related to lymphocyst development. We saw no complications strictly attributable to lymphocysts. The clinical import and treatment possibilities are discussed.

Teledermatopathology: a controlled study about diagnostic validity and technical requirements for digital transmission.

Telepathology is the practice of diagnostic histopathology performed on digital pictures. In this study, we focused on the technical requirements for achievement of a correct diagnosis on digital histopathologic images. A collection of 560 melanocytic lesions was selected from the files of the Department of Dermatology, Medical University of Graz, Austria. From each lesion one histologic slide was completely digitally scanned with a robotic microscope. Digital pictures were reviewed by 4 dermatopathologists using a presentation program, which recorded the number of image calls, applied magnifications, overall time needed, and amount of transmitted bits during the digital sign-out. One month later, the 4 microscopists had to review the corresponding slides and render a direct diagnosis on each case.Telepathologic diagnoses corresponded with the original diagnoses in a range from 90.4% to 96.4% of cases (κ 0.80 to 0.93; P < 0.001). The median time needed for achievement of a diagnosis was 22 seconds and was significantly higher for melanomas compared with nevi. The median transmission effort for each diagnosis was 510 kilobytes after JPEG compression. Using an ISDN line with a transmission capacity of 64 kilobits/ second, this correlates to a transmission time of about 1 minute.Our results demonstrate that correct reporting on digital histopathologic images is possible with only a little time exposure. For an adequately fast transmission ISDN lines are suffcient after JPEG compression.

Five-year results after anti-incontinence operations

OBJECTIVE This study was undertaken to evaluate continence rates 5 years after anterior colporrhaphy, anterior colporrhaphy with needle suspension of the bladder neck, and Burch colposuspension. STUDY DESIGN Among 544 women with stress incontinence who were operated on between 1989 and 1993, 327 women (60%) underwent clinical and urodynamic reevaluation 5 years after the operation. Choice of surgical procedure was made on the basis of clinical and urodynamic findings and of physician preference. Continence was defined as no loss of urine during cystometry or during coughing with the bladder filled to 300 mL. RESULTS The 327 patients underwent a total of 334 operations. The objective overall continence rates at 5 years were 61% (65/107) after anterior repair, 49% (59/121) after anterior repair with needle suspension, and 79% (84/106) after Burch colposuspension. Continence rates after anterior colporrhaphy were 82% (32/39) among patients with mild stress incontinence but 49% (33/68) among those with moderate or severe incontinence (P <.02). Continence rates among patients with moderate or severe incontinence were 49% (59/121) after anterior repair with needle suspension and 79% (84/106) after the Burch operation (P <.02). CONCLUSION Anterior colporrhaphy can cure mild stress incontinence but is inadequate to correct severe incontinence. Additional needle suspension may be of benefit for patients with moderate to severe incontinence. Abdominal colposuspension is superior to the vaginal operations for long-term cure of stress incontinence.

Observational study of respiratory syncytial virus-associated hospitalizations and use of palivizumab in premature infants aged 29-32 weeks

The national observational multicenter cohort study presented here was conducted over two respiratory syncytial virus (RSV) seasons (2001–2003) in Austria to collect data on RSV-related rehospitalizations in premature infants of 29 –32-weeks’ gestational age. The results revealed an overall RSV hospitalization rate of 4.5% (36/801). Risk factors were discharge from the neonatal intensive care unit between the months of October and December, birth between June and December 2002, and neurological disease. Palivizumab prophylaxis was given to 238 (29.7%) infants, and 148 infants received inadequate or incomplete courses. Respiratory syncytial virus (RSV) infection represents a major cause of rehospitalization during the first year of life in preterm infants [1]. Recommendations for RSV prophylaxis with palivizumab [2] have been adopted without major modifications in Austria [3], and they suggest that decisions regarding this drug’s administration should be based on local epidemiological data. Currently, very limited data are available on the risk of RSV-related rehospitalization in Austria [4]. Due to the fact that insurance companies allocate and reimburse prophylaxis with palivizumab in this group of premature infants differently from published recommendations and with great local variation, we initiated a nationwide observational cohort study. The study was aimed at collecting data on RSV-related rehospitalization of premature infants of 29–32-weeks’ gestational age in order to analyze associated risk factors and to assess the use of palivizumab prophylaxis in this population. Infants were included if their gestational age was between 29 (29+0) and 32 (32+6) weeks and if they were born between 1 June 2001 and 31 December 2002. All infants were followed up until 1 June 2003. For the first RSV season, data on all rehospitalizations were collected retrospectively from medical charts and by telephone calls: for the second RSV season, which occurred after the study was initiated in February 2002, data were collected prospectively. In cases of rehospitalization due to respiratory illness, the following data were collected: patient age in months, the month in which rehospitalization occurred, severity of respiratory illness (determined using the modified clinical lower respiratory illness/infection score [5]), length of stay, number of days with supplemental oxygen, number of days at the intensive care unit, and number of days with mechanical ventilation including nasal continuous positive airway pressure. RSVantigen detection was performed on nasopharyngeal aspirates using either enzyme-linked immunosorbent assays or immunofluorescence techniques. Viral cultures were not performed. Prophylaxis with monthly administered intramuscular injections of palivizumab was usually started at the end of October or beginning of November, with the last injection in March. Recommendations for prophylaxis were influenced by local differences in allocation and reimbursement of prophylaxis by the insurance companies. Prophylaxis administration was not influenced by the study protocol. The study was approved by the local ethics committee, and informed consent was given by the parents of those infants prospectively enrolled into the study. Statistical analyses were performed using the Pearson chi-square and Yate’s corrected chi-square test, as appropriate for categorical data, and the t-test and Fisher’s exact test, as appropriate for numerical data. Multivariate analysis was performed using a logistic regression model with backward elimination and the Wald criterion. Analysis was done with SPSS (SPSS, Chicago, IL, USA), and StatXact4 (Cytel, Cambridge, MA, USA) software. B. Resch (*) . W. Gusenleitner . W. D. Muller Division of Neonatology, Department of Paediatrics, Medical University Graz, Auenbruggerplatz 30, 8036 Graz, Austria e-mail: bernhard.resch@meduni-graz.at Tel.: +43-316-3852605 Fax: +43-316-3852678