N. Pateisky

Effects of smoking on uteroplacental blood flow.

The effects of nicotine consumption on uteroplacental blood flow were studied in 20 pregnant women by means of placental blood flow measurements using indium-113m-transferrin. Smokers were found to have a higher rate of poor perfusion patterns than subjects of a control group. In addition, the number of cigarettes smoked daily was significantly correlated with the placental perfusion type. The mean birth weight of infants born by smokers was 250 g lower than in the control group. The results suggest that smoking during pregnancy may compromise uteroplacental blood flow and thus result in poor fetal development.

Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy: a comparison between elective labor induction and spontaneous onset of labor beyond term.

SummaryBACKGROUND: Prolonged pregnancy is the most frequent reason for induction of labor. This study aims to determine the effects of labor induction on delivery outcome and to quantify the risks of cesarean delivery associated with labor induction in post-date pregnancies. PATIENTS AND METHODS: This retrospective case-control study included a total of 205 women who reached 42 weeks’ gestation (41 weeks and 3 days) between January 2002 and April 2004 and who were scheduled for induction of labor with vaginal prostaglandins. These cases were matched for age and parity with controls in spontaneous labor beyond 41 weeks’ gestation. Women with any additional medical or obstetric risk factors were excluded from the study. Maternal, neonatal and delivery outcomes were the main variables of interest. RESULTS: During the study period the data of 410 women were available for analysis. Our data revealed that the use of amniotomy (p = 0.02), oxytocin (p = 0.006) and epidural analgesia (p = 0.001) was increased significantly in the induction group compared with the control group of women with spontaneous onset of labor beyond term. The frequency of cesarean delivery and vacuum extraction was also significantly higher in the induction group (p = 0.0001). The Bishop score before induction was an important factor that affected the delivery outcome, resulting in significantly higher rates of cesarean section and vacuum extraction when the score was unfavorable (p = 0.0001). A univariate regression model revealed induction per se (p = 0.0001), primiparity (p = 0.0001), increased maternal age (p = 0.006) and an unfavorable Bishop score (p = 0.0001) as statistically significant risk factors for cesarean section. In a multivariate logistic regression model, primiparity (p = 0.03), increased maternal age (p = 0.02) and an unfavorable Bishop score (p = 0.01) remained independent risk factors for cesarean section. High infant birth weight was also an independent risk factor (p = 0.03). CONCLUSIONS: Our data suggest that women undergoing labor induction because of prolonged pregnancy should be sufficiently informed regarding the risks of a cesarean section or a vacuum extraction. Furthermore, the option of elective cesarean section should be considered, particularly in primiparous women with an unfavorable cervix, higher age, and high estimated infant birth weight.ZusammenfassungHINTERGRUND: Den häufigsten Grund für eine Geburtseinleitung stellt die Terminüberschreitung dar. Ziel dieser Arbeit war es, die Auswirkungen der Geburtseinleitung bei Patientinnen mit Terminüberschreitung auf den Geburtsmodus und auf andere mütterliche und kindliche Faktoren zu untersuchen. METHODIK: Zwischen Jänner 2002 und April 2004 wurden insgesamt 205 Frauen, die aufgrund einer Terminüberschreitung (Termin + 10) mit Prostaglandinen eingeleitet wurden, in diese retrospektive Fall-Kontroll-Studie eingeschlossen. Die Kontrollgruppe bestand aus 205 alters- und paritätsgleichen Frauen, die einen spontanen Wehenbeginn nach der 41 Schwangerschaftswoche hatten. Frauen mit medizinischen oder geburtshilflichen Risikofaktoren wurden von der Studie ausgeschlossen. ERGEBNISSE: Unsere Ergebnisse zeigten in der Einleitungsgruppe eine statistisch signifikant höhere Rate an Amniotomien (p = 0,02), einen erhöhten Oxytocingebrauch (p = 0,006) und eine höhere Rate an Epiduralanalgesie (p = 0,0001). Eine statistisch signifikant höhere Sectiorate und Vakuumrate war bei den eingeleiteten Patientinnen im Vergleich zu Frauen mit spontanem Wehenbeginn und Terminüberschreitung zu verzeichnen (p = 0,0001). Der Zervixbefund (evaluiert durch den Bishop Score) vor der Einleitung hatte einen wichtigen Einfluss auf den Geburtsmodus, wobei bei einem ungünstigem Bishop Score sich eine statistisch signifikant höhere Rate an sekundären Sectiones und Vakuumextraktionen fand (p = 0,0001). In einem univariaten logistischen Regressionsmodell waren die Einleitung per se (p = 0,0001), die Primiparität (p = 0,0001), ein erhöhtes mütterliches Alter (p = 0,006) und ein ungünstiger Bishop Score (p = 0,0001) signifikante Risikofaktoren für eine Entbindung per sectionem. Im multivariaten logistischen Regressionsmodell blieben die Primiparität (p = 0,03), ein erhöhtes mütterliches Alter (p = 0,02) und ein ungünstiger Bishop Score (p = 0,01) unabhängige Risikofaktoren. Zusätzlich zeigte sich, dass ein hohes kindliches Geburtsgewicht (p = 0,03) ebenfalls einen unabhängigen Risikofaktor darstellte. SCHLUSSFOLGERUNG: Die Ergebnisse unserer Studie weisen darauf hin, dass Frauen, die aufgrund einer Terminüberschreitung eingeleitet werden, über das erhöhte Risiko einer sekundären Sectio oder einer vaginal-operativen Entbindungsart informiert werden sollten. Bei erstgebärenden Patientinnen mit unreifem Zervixbefund, einem geschätzten hohen kindlichen Geburtsgewicht sowie erhöhtem mütterlichen Alter sollte auch die Möglichkeit einer elektiven Sectio caesarea in Betracht gezogen werden.

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.

Diagnostic and intraoperative immunoscintigraphy in ovarian cancer

A new strategy for tumor detection using immunoscintigraphic techniques was used in an attempt to improve the diagnostic potential of conventional external immunoscintigraphy. Twelve patients who were strongly suspected to either suffer from primary or recurrent ovarian cancer were investigated as follows: radioimmuno-scintigraphy (RIS) by means of radiolabelled antibodies was performed in all patients prior to operation (first or second look). During the operative procedure, which always took place immediately after completion of the diagnostic RIS, a hand-held gamma-ray detection probe, especially developed for this purpose was used for the purpose of identifying radiolabelled tumor sites intra-operatively in the open abdomen. In 10 out of 12 of the investigated patients, Radioisotope-Assisted Surgery (RAS) could be performed successfully. The count rates in cancer sites ranged from 150-250 cts per 6 s vs. 30-50 cts per 6 s in normal tissues. While the presence of malignant-tumor sites could always be predicted by conventional RIS, RAS failed twice, but revealed more accurate information concerning the real extent of the disease.

Immunolymphscintigraphy with BCD-F9 Monoclonal Antibody and Its F(ab’)2 Fragments for the Preoperative Staging of Breast Cancers

In breast cancer, assessment of axillary lymph node status is the most important prognostic factor for accurate staging, management and follow-up of patients with primary tumors. Several studies suggest that preoperative staging with techniques as direct breast lymphography, ultrasound and CT-scan often fail to identify the extent of the metastatic involvement in the axilla. To this end, we have developed a novel, simple, non-invasive and reliable immunolymphscintigraphic(ILS) technique that allows the accurate preoperative diagnosis of lymph node metastasis in patients with early stages of breast cancer1–4. In this article, we report on a consecutive series of thirty-nine breast cancer patients undergoing preoperative staging by ILS using the BCD-F9 monoclonal antibody or its F(ab’)2 fragments. Each patient received 1 mg of a purified preparation containing 1 mCi of Iodine-123, by a subcutaneous injection into the fingerwebs between the 2nd and 3rd finger of both hands. Scans obtained 4, 8 and 12 hours after injection demonstrated adequate tumor accumulation of radiolabeled antibody and accurate tumor visualisation without any background substraction. ILS results were always compared to the histopathological staging. When intact immunoglobulin molecules were injected, 10 out of 11 patients with breast cancer were true positives and 19 out of 21 were true negatives. For the F(ab’)2 fragments, ILS results were positive in 3 out of 3 patients with metastatic cancer and negative in 3 out of 4 patients without metastatic involvement of the axilla. Most importantly to our study, all of the 12 patients with benign breast disease studied showed no positive imaging.

Prostacyclin Does Not Influence Placental Blood Pool in vivo

In 20 healthy pregnant women placental blood pool was estimated by means of placental scintigrams before, during and after infusion of either prostacyclin (PGI2) or placebo for 10 min to study the effect of PGI2 on the local regulation of uterine blood flow. There was no difference in the mean number of counts between the PGI2- and the placebo-treated group. Therefore no effect of PGI2 on uteroplacental blood pool could be detected in healthy gravidae.

4 Radio-immunoscintigraphy and intraoperative tumour detection by means of anti-tumour antibodies in patients with ovarian cancer

Summary A hand-held gamma-ray detection probe was developed by us to circumvent the problems of conventional radio-immunoscintigraphy (RIS). The intraoperative use of this probe in terms of radionuclide-assisted surgery (RAS) should help to overcome problems associated with insufficient accumulation by the tumour of the radio-active antibodies, unfavourable localization of tumour sites, collimation problems, etc., in patients with ovarian cancer. The probe was designed as a scintillation counter. Twelve patients were operated upon and investigated by RAS. It could be shown that RAS is able to detect tumour tissue intraoperatively, although we have already seen that improvements in the probe are necessary to make the method of real clinical value.

Lymphszintigraphie mit 123I markiertem epidermalem Wachstumsfaktor beim Zervixkarzinom

Verschiedene maligne Neoplasien exprimieren in hohem Masse Rezeptoren fur den epidermalen Wachstumsfaktor. Ziel dieser Studie war zu prufen, ob 123I-markierter epidermaler Wachstumsfaktor i

CA-12 Tumormarker-Werte in Serum nach Radio-Immuno-Szintigraphie

Dr. M. Barrada, I. Universitäts-Frauenklinik, Spitalgasse 23, A-1090 Wien Sowohl die Bestimmung des Tumormarkers CA-125 im Serum als auch die Immunszin-tigraphie (IS) haben einen hohen Stellenwert in der Diagnostik und vor allem in der Nachsorge beziehungsweise Verlaufskontrolle von epithelialen Ovarialkarzinomen erreicht. Bei beiden Methoden wird der gleiche monoklonale Antikörper (MAK), OC-125, verwendet. An der I. Universitäts Frauenklinik erfolgte die Bestimmung des CA-125 im Serum mittels eines Radio Immuno Assays der Fa. Centocor. Für die IS wurde ein Kitt der Fa. Biomedica, IMACISTI, verwendet. Ziel dieser Studie war es, den Einfluß der parenteralen Applikation der MAK im Zuge der IS auf die Serumwerte des Tumormarkers CA-125 zu untersuchen. Dazu wurden bei 20 Patientinnen die CA-125 Werte in jeweíls 5 Blutproben, die kurz vor bis einschließlich 8 Tage nach Applikation der Radioantikörper zur Durchfüh-rung der IS abgenommen wurden, bestimmt. In 8 Fallen konnten die CA-125 Serumwerte auch nach 3 Monaten bestimmt werden. In der Tabelle 1 sind sämtliche erhobenen Werte des Tumormarkers CA-125 aufgelistet. Zur statistischen Auswertung der Ergebnisse wurde der Signed Rank Test verwendet. Der Abfall der Werte nach nach einer Stunde post injektionem (p. i.) des radiomarkierten MAK war hoch signifikant (p < 0,001). Ebenso sind die Werte vom 1. und 3. Tag p. i. gegenüber dem Vorwert statistisch signifikant niedriger (p < 0,001). Die Werte 8 Tage p. i. sind trotz eines leichten Wiederanstieges noch immer statistisch signifikant niedriger als die Vorwerte (p < 0,008). In den 8 Fallen, wo auch Werte nach 3 Monaten vorliegen, zeigte sich eine Tendenz zu einer deutlichen Erhöhung gegenüber den Vorwerten, die aber nicht statistisch signifikant war (p = 0.24). Für den Abfall der Werte innerhalb der ersten Woche dürfte die Abbindung der frei zirkulierenden CA125 Antigene durch die injizierten MAK verantwortlich sein. Eine mögliche Erklärung für die Vorträge zum 2. Hauptthema 73 Tabelle 1. Ca-125 Serum-Werte vor und nach IS

Ovarialkarzinom nach Hysterektomie

Im Beobachtungszeitraum von 1978 bis 1988 wurden 538 Patientinnen mit primarem Ovarialkarzinom an unserer Abteilung behandelt. Von diesen waren 37 bereits hysterektomiert. Zum Zeitpunkt der Diagnose des Ovarialkarzinoms waren 28/37 (75,7%) im Stadium III oder IV nach FIGO. Theoretisch hatten diese 37/538 (6,8%) unserer Ovarialkarzinome durch prophylaktische Ovarektomie im Zuge der aus verschiedenen Grunden vorangegangenen Hysterektomie verhindert werden konnen.