[Arterial regional chemotherapy of advanced breast cancer]

From October 1985 to November 1987, arterial regional chemotherapy with mitoxantrone was undertaken in 18 patients with primary far advanced carcinoma of the breast, of inflammatory or ulcerating type. Two patients had a bilateral carcinoma. Eight weeks after regional chemotherapy 18 of 20 tumours had become operable. Regression of tumour size by at least 50% (checked by mammography) was achieved in seven patients. Axillary lymphadenectomy gave negative results in 6 of 17 patients. Conversion of the receptor status occurred in only 2 of 12 patients. There were only few side effects: alopecia in 20%, leucopenia less than 2,500/microliters in 18%, thrombocytopenia less than 100,000/microliters in 7% patient. After a follow-up period of up to 28 months local recurrence was noted in two, distant metastases in three cases. A totally disease-free period was achieved in 14 patients.

Veränderungen gerinnungsphysiologischer Parameter durch orale Antikonzeption mit einem Desogestrel-haltigen Zweiphasenpräparat bei Rauchern und Nichtrauchern

In einer prospektiven Studie wurden gerinnungsphysiologische Untersuchungen bei 7 Raucherinnen und 9 Nichtraucherinnen vor, während und nach ómonatiger Einnahme eines Zweiphasen-Ovulationshemmers mit 0,05 mg Äthinyl-Östradiol (EE) bzw. 0,05 EE + 0,125 mg Desogestrel (Oviol®) durchgeführt. Gerinnungs-übersichtstests zeigten nur unwesentliche Veränderungen. Die Aktivität der Gerinnungsfaktoren I, VIII und X stieg um 10 bis 30%, die des Faktor VII um maximal 40% an. Die AT-III-Aktivität sank, die Protein-C-Aktivität fiel um jeweils etwa 10%. Die Antiplasminaktivität blieb unverändert. Bei den Raucherinnen fand sich eine Verkürzung der Euglobulinlyse-zeit. Die Werte für Fibrinopeptid A und D-Dimer stiegen gering, jedoch signifikant an und sanken nach Beendigung der Ovulationshemmer-Ein-nahme verzögert ab. Diese Befunde deuten auf eine begrenzte Gerinnungsaktivierung mit reaktiver Fibrinolyse hin.

[Value of gynecologic sonography within the scope of preoperative diagnosis. I. Retrospective evaluation of clinically and sonographically suspected diagnoses in 1,168 patients]

In 1168 women patients operated on between January 1981 and July 1984 at the Department of Gynaecology of the University of Tübingen it was possible to control retrospectively the suspected diagnoses that had been made preoperatively, both clinically as well as sonographically, the control being based on an examination of the site of operation and/or the histological preparation. Sonographic examination was mostly effected after clinical examination while being aware of the clinically suspected diagnosis. Preoperative clinical diagnosis was found to be mostly correct in 816 patients (69.9%). After subsequent sonographical examination the proportion of correct diagnoses rose to 961 cases (82.3%). The diagnostic "positive addition"--a total of 145 cases (12.4%)--represents a significant improvement in preoperative clinical diagnosis (p less than 0.001), especially also in the diagnosis of carcinoma of the ovary (p less than 0.05). No impairment of sonographic diagnosis was seen as a result of obesity. In addition, it was also possible to clarify by sonography another 73 cases of 107 that had remained unclear after clinical examination (68%). The results are discussed in detail, broken down according to 19 typical gynaecological diagnoses. For the clinician it is quite evident that there are clear indications for the additional use of sonography after clinical examination. In the following prospective part II of the study this result is analyzed in respect of its causes by clinical and sonographic examination conducted independent of each other.

Progesterone and 5 alpha-pregnane-3,20-dione in human amniotic fluid

Progesterone and 5 alpha-pregnane-3,20-dione (5 alpha-DHP) were determined by radioimmunoassay in 242 amniotic fluid samples from 16-19 weeks of gestation. 165 samples fulfilled the criteria of the normal collective. There is a positive correlation (r = 0.359, p less than 0.001) between progesterone and 5 alpha-DHP. The mean concentration (+/- SD) of progesterone for normal pregnancies was 68.04 +/- 35.56 ng/ml, the mean for 5 alpha-DHP was 6.6 +/- 4.76 ng/ml. A slight decrease of the hormone concentrations with increase of the week of gestation was observed. 7 cases, who later developed EPH-gestosis showed a significant higher progesterone concentration (p less than 0.05). 16 women with premature labor had a significant higher 5 alpha-DHP concentration (p less than 0.05). Significantly elevated progesterone and 5 alpha-DHP values were found in 36 cases of bleedings in early pregnancy. Pregnant women older than 35 years proved to have a significant higher 5 alpha-DHP concentration (p less than 0.05). Also women, who delivered a child weighing less than 2,500 g (n = 8), showed a significant higher progesterone concentration (p less than 0.01). There was no difference in amniotic fluid progesterone and 5 alpha-DHP concentration depending on the sex of the child. The hormone concentrations of 3 cases with Morbus Langdon-Down were slightly below the mean concentration for progesterone and 5 alpha-DHP. Progesterone and 5 alpha-DHP concentrations were found to be normal in one case each of open Ductus Botalli, esophagial atresia, conjunctival bleeding with eyelid edema, teleangiectasia, Morbus Gaucher, sicklefoot, omphalocele, clubfoot, and stillbirth respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Therapy with gestagens in hyperplastic changes of the endometrium]

Forty-six patients with premenopausal or postmenopausal bleeding anomalies were given gestagen therapy for endometrial hyperplasia. The therapy was carried out using medroxyprogesterone acetate (MPA) or norethisterone acetate (NEA), in each case 10 mg/day either continuously or for 10 days per cycle. Therapy was controlled either by fractionated curettage or hysterectomy or on the basis of the subsequent clinical course. In the literature a regression of the endometrial hyperplasias in most cases under gestagen therapy has been described, and no case of development of carcinoma following therapy has been reported. These facts were confirmed in the patients treated with MPA, while among the women treated with NEA there were carcinomatous changes in three cases and progressive histologic control findings in three others. A pathologist asked to give a second opinion confirmed the diagnosis of carcinoma in one patient, but classified the histologic changes in the other two not as carcinomatous, but as adenomatous hyperplasia. The patient with confirmed corpus carcinoma had undergone a cyclic six-month course of therapy with only 5 mg NEA/day. Recurrent bleeding anomalies under therapy occurred less frequently among the patients treated with MPA than among those treated with NEA.

[Premature menopause]

In 46 patients with the diagnosis of "premature menopause" menstrual history, clinical findings and hormonal quantitations were analysed. This clinical entity was evaluated with regard to a rapid verification of the diagnosis. The age of the investigated women with secondary failure to menstruate varied between 13 to 39 years (mean value 29 years). Menstrual history varied considerably. 20 women complained about menopausal symptoms. 5 women had adnexal operations before. Vaginal hormonal cytology, gestagen test and quantitation of the circulating oestradiol concentrations were of little value for establishing the diagnosis, since many of these women revealed premenopausal oestradiol levels. Quantitation of FSH is decisive for establishing the diagnosis. In women under the age of 40 with FSH values above 1000 ng LER 907/ml or above 40 mIU/ml premature ovarian failure can be assumed; however, in individual cases the "gonadotropin resistant ovary syndrome" must be differentiated.

Diagnosis and treatment of vulvar carcinoma in situ with anal involvement in young women. Two case reports and literature review

The diagnostic procedure and therapy of carcinoma in situ of the vulva and the anal region are presented by reporting two cases of young women. The rising incidence of the multifocal lesions with a high recurrence rate after treatment is discussed and the relevant literature is reviewed.

[Nonpuerperal mastitis]

The medical history of 37 women with nonpuerperal mastitis, who had been treated between January 1980 and July 1983 at the Dept. of Obstetrics and Gynaecology of the University of Tübingen, was reviewed because of the increasing prevalence of this disease. Defined by different history and clinical symptoms, two groups of patients were seen: 25 women with acute nonpuerperal mastitis and 12 women with chronic recurring nonpuerperal mastitis. The average age of the patients was 30 years. The inflammation was located mostly subareolar and around the nipple. The main symptoms were pain, erythema and swelling, in acute cases accompanied by fever and abscess formation. This process was strongly related to the interval between the onset of symptoms and the initiation of treatment. Anaerobes and Staphylococcus aureus could be cultured mainly from women with acute nonpuerperal mastitis. In females with chronic recurrent mastitis, mostly anaerobes were found. Women were treated with a prolactin inhibitor (bromocriptine), if abscess formation, leukocytosis or fever were absent. In patients with leukocytosis and/or fever this regimen was combined with antibiotics. Abscesses were treated surgically, in some cases in combination with prolactin inhibition and antibiotic administration. The results show that an early conservative treatment is important to prevent abscess formation. It seems that this treatment can reduce the rate of recurrences.

[Comparison of a 2-phase preparation (Oviol 22) with a low-dose 1-phase preparation (Ovoresta M)]

Oviol 22 was administered to 145, and Ovoresta M to 118 healthy female volunteers. During the first six cycles, 27 (18.6%) women discontinued the Oviol 22 intake, and 45 (38,1%) women discontinued the Ovoresta M intake. The other women were observed over 6 cycles. Together, 1,369 cycles were evaluated. Overall, the clinical results with Oviol 22 were more favourable than those with Ovoresta M. The discontinuation rate because of nausea, headache, acne and breast tenderness was lower in the group of women who received Oviol 22 than in the group of women receiving Ovoresta M. Cycle control was much better with Oviol 22 than with Ovoresta M. Following the administration of both preparations, no significant alteration in blood pressure, weight or mental status was seen. None of the patients became pregnant during the period of observation.

[Clinical aspects of genital cancer in women]

The clinical significance of cancer frequency, tumor status, and age at the time of cancer detection, was evaluated from 1957 to 1980 in women treated at the Department of Obstetrics and Gynaecology at Tuebingen University for ovarian, endometrial and cervical cancer. From the presented data the following conclusions can be drawn: The data emphasize the value of epidemiologic studies in gynaecologic oncology. It is not sufficient to consider the frequency of cancer detection, since the clinical significance is determined not so much by the number of diseased women, but rather by the stage of cancer spread and age of the patients at the time of cancer diagnosis. The most important change among the genital cancers of women appears to be the absolute and relative increase in pre-invasive and invasive lesions of the cervix in young women. No change or increase in the prognostically unfavourable cases of stages III and IV of cervical and ovarian cancers.

The effects of endocrine therapy on plasma steroids in prostatic carcinoma patients

Plasma testosterone (T), 5 alpha-dihydrotestosterone (DHT), T/DHT ratio, estrone (E1), estradiol (E2), E2/T ratio and 17-hydroxyprogesterone (17-OH-P) were measured in 70 patients with prostatic carcinoma (PCA) (T34, N01, M01), after endocrine therapy including: steroidal estrogens (polyestradiol phosphate = Estradurin monthly in injections of 80 mg; estradiol - 17 beta: 5 mg/d), nonsteroidal synthetic estrogens (DES: 5 mg/d; chlorotrianisene = TACE: 24 mg/d; DES-diphosphate = Honvan: 360 mg/d), orchidectomy and their combinations. All these forms of treatment lowered T, DHT, T/DHT ratio and 17-OH-P, the maximal suppression being observed after castration. No further decrease of the mentioned parameters was achieved by estrogen treatment of castrated patients, as compared with castration alone. In the noncastrated patients, steroidal estrogens were less effective than nonsteroidal ones, in terms of lowering T, DHT and T/DHT ratio. Significant decreases in estrone (p less than 0.05) and estradiol (p less than 0.01) levels were observed after nonsteroidal estrogen treatment and castration respectively, and extremely high values of circulating estrogens were found after steroidal estrogen administration.

Radioimmunoassay of 5 alpha-pregnane-3,20-dione. A metabolite of placental progesterone

A radioimmunoassay (RIA) procedure has been developed for the measurement of 5 alpha-pregnane-3,20-dione (DHP) in human plasma after ether extraction of the plasma-samples, followed by column chromatography. The antiserum was generated in rabbits with 6 alpha-carboxyethylmer-captoprogesterone-BSA conjugate. The high affinity (Ka = 3.72 X 10(9) l/mol) antiserum binds 40% of 40 picograms of tritiated 5 alpha-pregnane-3,20-dione at working dilutions of 1 : 2800. Negligible cross-reactivity of the antiserum was detected with 5 beta-pregnane-3,20-dione (1.8%). Other hydroxylated pregnanes showed minor cross-reactivity (5-40%). The cross-reacting steroids were all separated from pregnanedione by one chromatographic step. The plasma levels of 5 alpha-pregnane-3,20-dione were measured from 22nd to 42nd week of normal pregnancy and compared to published data.

Estradiol and progesterone receptor levels in human breast cancer in relation to cytosol and plasma estrogen level

Estradiol receptor (ER) and progesterone receptor (PR) content along with the cytosol and plasma estrone and estradiol levels in 15 premenopausal and 26 postmenopausal women with breast cancer in different clinical stages (T123, N01, M0) were measured. ER-positive tumor frequency and the ER content tended to be higher in postmenopausal than in premenopausal patients. There was no evidence for a relationship between high cytosol estrogen levels and low receptor measurements. The estrogen concentration was higher in ER-positive tumor cytosols than in those of ER-negative tumors; the differences were significant in postmenopausal women, only, with P less than 0.05 for estrone and P less than 0.01 for estradiol values. Twelve pairs of tumor and normal tissue from the same breast, were also studied: seven of which contained ER-positive and five ER-negative tumors. The ER-positive tumors showed a clear trend to higher estradiol content as compared to the corresponding normal tissues. The circulating level of estradiol in postmenopausal women, was higher (P less than 0.05) in ER-positive tumors than that in ER-negative tumors. Our results indicate that: (a) false negative ER assays are not likely to be due to the presence of endogenous estrogens. (b) higher amounts of estrone and estradiol are contained in ER-positive tumors than in negative ones.