W. Lichtenegger

Nitroglycerin to facilitate fetal extraction during cesarean delivery.

Objective To determine the long-term outcomes of children exposed in utero to maternal parvovirus B19 infection. Methods All pregnant women with serologic evidence of recent parvovirus B19 infection and a comparison group with serologic evidence of past infection from January 1988 to December 1994 were sent questionnaires or contacted by phone about the health and development of their children. Information requested included: pregnancy complications, date of delivery, birth weight, sex, birth defects, need for special care, significant health problems, and developmental delays. All women had serology done at either the Centers for Disease Control and Prevention or the virology laboratory of the Connecticut Department of Health. The data were analyzed using descriptive statistics, χ2 analysis with Fisher exact test, or Student t test in appropriate cases. P < .05 was considered significant. Results Outcome information was obtained from 113 of 117 immunoglobulin-M positive women. The 113 respon-dents had 103 term singletons, two sets of twins (of which one neonate died of complications of prematurity), one hydropic stillborn, four spontaneous abortions, and one ectopic pregnancy. The mean gestational age at time of exposure was 15.6 weeks. The median age of the liveborn infants in study and comparison groups was 4 years. Eight of the 108 (7.3%) surviving children, one set of twins (exposed at 27 weeks), and six singletons (exposed at 7, 8, 9, 20, 27, and 35 and 35 weeks) had developmental delays in speech, language, information processing, and attention. Outcomes were obtained for 99 of 110 patients with past infection; they had 83 liveborn singletons, five sets of twins, two stillborns, and five spontaneous abortions. Seven of the 93 (7.5%) children had developmental delays, similar to the study group. Post-hoc power analysis revealed that 712 infected patients would be needed to find a twofold difference in the risk of abnormal neurologic development; our study had 30% power to find such a difference. Conclusion There is no apparent increase in the frequency of developmental delays in children with exposure in utero to parvovirus, but larger studies are needed.

Operative Results after Primary and Secondary Debulking-Operations in Advanced Ovarian Cancer (AOC)

Objective:To assess the role of primary and secondary radical surgery in advanced ovarian cancer (AOC).

Immunostaining of p53 protein in ovarian carcinoma: Correlation with histopathological data and clinical outcome

Objective: The objective of this study was to analyze the incidence of immunohistochemically detectable p53 protein accumulation in epithelial ovarian carcinomas and to correlate these data with the clinical outcome so as to clarify further the role of p53 mutations in prognosis with these patients.Methods: Tumor tissues from 179 patients with epithelial ovarian carcinoma were used for immuno-histochemical analysis with monoclonal antibody DO1 and BP 53-12-1 on formalin-fixed, paraffin-embedded tissue.Results: A total of 78 cases (44%) showed positive nuclear p53 staining. The p53-positive cases were found in all histological types of epithelial ovarian tumors. p53 staining was found in tumors of all stages with a higher percentage of positive cases in stage IV ovarian carcinomas (not significant). Poorly differentiated carcinomas showed a significantly higher percentage of p53 protein expression than did highly differentiated tumors (P=0.0002). Clinical follow-up of up to 14 years (median 25 months) showed a slightly but not significantly shortened disease-free and overall survival time for patients with p53-positive epithelial ovarian carcinomas.Conclusions: We conclude from our data that p53 expression in ovarian carcinoma is associated with poor differentiation but not with the disease being in an advanced stage. There was a tendency for shortened disease-free and overall survival for patients with p53-positive tumors.

Comparison of various imaging methods with particular evaluation of color Doppler sonography for planning surgery for breast tumors.

Abstract.Objective: Color Doppler sonography (CD) was compared with other diagnostic imaging methods [mammography (MG), breast ultrasound (US) and magnetic resonance imaging (MRI)] in the planning of surgery for breast tumors. Materials and methods: 99 patients with breast cancer and 101 with ultimately benign breast lesions were examined preoperatively. The specificity and sensitivity were calculated, as well as the predictive values. Various qualitative and semi-quantitative CD parameters were also analysed for their diagnostic value. Results: The sensitivity/specificity of the various methods (in %) was: MG 85/77; US 95/80; CD 82/75; MRI 90/63. The positive predictive value (ppv)/negative predictive value (npv) (in %) was: MG 79/83; US 81/94; CD 72/84; MRI 79/63. The median maximum systolic flow velocity and the resistance index (RI) were significantly higher in breast cancer vessels than in benign lesions. The number of pulsating color pixels detected by CD was significantly higher for breast cancer. In cases of breast cancer significantly more blood flows were detected in the body of the tumor than at its periphery. Conclusion: Color Doppler sonography was not superior to other diagnostic methods for preoperative assessment of a breast lesion. The combination of all diagnostic procedures gave a correct classification rate of 93.3% and is much better than the correct classification of any single diagnostic imaging procedure.

Case Report. Boeck Sarcoidosis of the Breast: Mammographic, Ultrasound, and MR Findings

The rare case of sarcoidosis of the breast is presented. The mammographic, ultrasound, and MR appearances are described.

A new therapeutical approach: Topotecan plus gemcitabine in the treatment of patients with relapsed ovarian cancer after failure of first‐line chemotherapy with paclitaxel and platinum

Aim:u2002 Topotecan and gemcitabine have demonstrated mono‐activity against recurrent ovarian cancer. Both drugs affect DNA replication; in addition, topotecan inhibits DNA repair. Based on the efficacy profiles and different mechanisms of action, a phase‐I study was conducted to determine the maximum tolerated dose (MTD) of topotecan (dayu20031–5) and the dose‐limiting toxicities (DLT) in combination with gemcitabine (dayu20031u2003+u20038) every 21u2003days.

Dose Finding Study for Combination Treatment with Topotecan and Gemcitabine of Patients with Recurrent Ovarian Cancer after Failure of First-Line Chemotherapy with Paclitaxel and Platinum

Objective: Topotecan and gemcitabine have shown mono-activity against different solid tumors including recurrent ovarian cancer after failure of platinum- and paclitaxel-containing therapies. Both drugs affect DNA replication, topotecan additionally inhibits the DNA repair process. Efficacy profiles and different mechanisms of action make the combination of both drugs a promising regimen. Therefore the following dose-finding study was conducted to determine the maximum tolerated dose (MTD) and the dose-limiting toxicities (DLT) of this combination. Based on the monotherapy schedules topotecan was given on day 1–5, and gemcitabine on day 1 + 8 every 21 days. Patients and Methods: Patients with histologically proven ovarian cancer who relapsed after platinum- and paclitaxel-containing therapy were enrolled. 3 different dose levels were investigated. No individual dose escalation or primary use of cytokines were allowed. Results: 23 patients were enrolled, 50% were pretreated with at least 2 platinum-containing therapies; 80 courses were analyzed for toxicity. Thrombocytopenia and leucopenia were the major DLTs. The MTD for phase II trials is 0.50 mg/m² topotecan and 800/600 mg/m² gemcitabine. In this dose level only one therapy-related non-hematological adverse event >grade 2 (grade 3 mycotic stomatitis) and one grade 4 thrombocytopenia occurred. Responses were observed in 6 and stable disease in 4 out of 12 evaluable patients. Median survival was 15.3 (95% CI: 13.2–28.6) months. Conclusion: The results of this phase I study demonstrate the feasibility and tolerability of this new combination in heavily pretreated patients. Based on these results a phase II study was initiated to evaluate the efficacy of this regimen.

Increased Incidence of Cervical Intraepithelial Neoplasia in Young Women in the Mitte District, Berlin, Germany

OBJECTIVEnTo investigate whether the incidence of cervical intraepithelial neoplasia (CIN), in particular of high grade CIN, increased in Berlin during the period 1970-1989 and whether the ages of women with CIN had decreased.nnnSTUDY DESIGNnIn the former German Democratic Republic, which had a highly centralized public health system, all gynecologic operations performed on women living in the Mitte district of Berlin were carried out during the period 1970-1989 (when the Berlin Wall fell) in the gynecologic clinic of the Charité Hospital.nnnRESULTSnThe incidence of all CIN increased from year to year over the observation period: 0.04% (1970-1971), 0.10% (1980-1981), 0.39% (1988-1989). There was a particularly high increase in the incidence of high grade intraepithelial neoplasms (CIN 3): 0.016% (1970-1971), 0.056% (1980-1981), 0.25% (1988-1989). With a virtually unchanged age distribution for women in the Mitte district of Berlin, the median age of women with CIN 3 decreased significantly from 1970 to 1989, from 39.5 (1970) to 33 (1989) (P < .001).nnnCONCLUSIONnThe increase in the incidence of CIN, especially of high grade CIN, as well as the reduction in age for onset of the disease, makes high participation in screening necessary, above all among young women.

Primary Mucinous Adenocarcinoma of the Appendix: A Rare Entity in the Differential Diagnosis of Ovarian Cancer

We report a 58‐year‐old female patient with the suspected diagnosis of ovarian cancer. Upon surgical exploration, examination of the appendix revealed the histological diagnosis of primary mucinous adenocarcinoma. This is an unusual consideration in the differential diagnosis of the ovarian cancer. We discuss the diagnosis, classification and treatment of the cancer of the appendix in relation to ovarian cancer.

Relevance of sonographic criteria for differential diagnosis of mammary tumours

Abstract Objective : A prospective study was performed to determine the relevance of sonographic criteria for the differentiation of mammary tumours using high-resolution sonography. Methods : Two high-resolution ultrasonographic devices (7.5 and 10 MHz linear array transducer) were used for preoperative examination of 310 patients with focal breast findings (including 97 cancers and 213 benign breast diseases). The diagnostic relevance of sonographic criteria was analysed for the differentiation of breast cancer among all surgically removed tumours or punctured lesions. This was done by calculating sensitivity, specificity, positive and negative predictive values and the odds ratio (OR). OR is very much suited to summarize the statistical findings from benign lesions. Results : The irregular and ill-defined tumour margin (OR=378), change of breast architecture (OR=230), absence of lateral edge shadowing (OR=49) as well as non-compressibility (OR=31) proved to be the best criteria. Low internal echogenicity (OR=0.45) and the presence of internal echo patterns (OR=0.69) did not indicate malignancy. Conclusion : The best criteria for distinguishing between malignant and benign tumours using high-resolution ultrasound are the irregular and ill-defined tumour margin and alterations of breast architecture.