Management of genital fistulas in patients with cervical cancer

Among 2096 patients treated for cervical cancer between 1985-1995, genital fistulas developed in 38 cases (1.8%). 16 patients were affected by rectovaginal, 13 patients had rectovesicovaginal and 9 patients had vesicovaginal fistulas. Median age at time of first presentation of the fistulas was 54.8 years. Fistula size ranged from 0.1 to 2.0 cm in diameter. Faecal or urinary leakage through the vagina (44.7%), bleeding (31.5%) and local pain (5.3%) were major clinical symptoms. 10 patients had surgery for the fistula, the remaining patients were managed conservatively.

Intestinal obstruction in patients with advanced gynecological cancer. A study of 62 cases

In total, 62 cases with advanced gynecological malignancy were analyzed for the value of interventions for intestinal obstruction. 35 patients had an ileostomy, 7 patients had other palliative surgical intervention and 20 patients were managed conservatively. The median survival after surgical intervention was 7.7 months as against 1.3 months in conservatively treated patients. After surgery, all patients were affected by severe complications due to the primary disease. 22 (52.3%) of surgically treated patients received further therapy. 45 out of 62 patients (77.4%) died of progressive cancer and 14 (22.6%) of ileus. Surgical intervention had a positive effect on survival time, but only a marginal effect on life quality.

Electrophysiologic evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea

In 15 patients with ventricular asystole of 8.5 +/- 3.5 seconds (range 5.0 to 16.8) occurring exclusively during obstructive sleep apnea, electrophysiologic study of sinus node function and atrioventricular conduction before and after administration of intravenous atropine (0.02 mg/kg) was performed. Electrophysiologic parameters of sinus node function were normal in 12 of 15 patients (80%) and atrioventricular (AV) nodal function was normal in 7 patients (47%). Almost all abnormal findings of sinus node function and AV nodal function were reversible by administration of atropine. The HisPurkinje system function was normal in 6 patients (40%). Prolonged HV intervals (57 to 73 ms) were found in 9 patients (60%). Intra- or infra-His block was not observed in any patient. In summary, electrophysiologic parameters of sinus node function and AV conduction were normal or only slightly abnormal in all 15 study patients, which suggests that prolonged ventricular asystole during obstructive sleep apnea is not due to fixed or anatomic disease of the sinus node or the AV conduction system.

Intron-specific stimulation of anaerobic gene expression and splicing efficiency in maize cells

Most of the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes characterized in plants and algae to date have one intron very close to the 5' end of the gene. To study the functional relevance of some of these introns for gene expression we have analysed the influence of three 5' introns on transient gene expression of the anaerobically inducible maize GapC4 promoter in maize cells. Under aerobic conditions, reporter gene expression is increased in the presence of the first introns of the GapC4 and GapC1 genes, and the first intron of the nuclear encoded chloroplast-specific GapA1 gene. In contrast, the GapC4 intron increases anaerobic gene expression above the level obtained for the intronless construct, while anaerobic expression of constructs harboring the GapA1 and GapC1 introns was similar to the anaerobic expression level of the intronless construct. Splicing analysis revealed that the GapC4 intron is processed more efficiently under anaerobic conditions, while no change in splicing efficiency is observed for the GapC1 and the GapA1 introns when subjected to anaerobic conditions. These results suggest that an increase in splicing efficiency contributes to the anaerobic induction of the maize GapC4 gene.

Relations between various DNA-parameters and degree of malignancy in endometrial carcinoma

120 imprint-cytology specimens obtained from standardized areas of 20 endometrial carcinomas were investigated by use of a computed-controlled image analysis system to determine special quantitative DNA-parameters. The stem line ploidy, the 2c deviation index (2cDI), the DNA-associated graduation of malignancy (DNA-MG) as well as the 5c exceeding rate (5cER) were calculated for each preparation. 85% of the imprint-cytology preparations had diploid stem lines, and aneuploidy was found in 15%. There were statistically significant correlations between the DNA-MG, the 5cER and the stem line ploidy as well as between the DNA-MG and the 5cER. The sensitivity of the 5cER was 76.6% in our study and so we cannot regard this parameter as prouding accurate information about tumor malignancy in endometrial carcinoma. Special DNA-parameters defined mathematically should be utilized for objective grading of tumor malignancy.

[Vaginal hemorrhage after hysterectomy as a complication of alcohol-induced liver cirrhosis]

We report on a 50-year-old woman with a decompensated alcoholic liver cirrhosis and Korsakow syndrome since 1991. In July 1992, an abdominal hysterectomy with bilateral salpingoophorectomy was made because of an endometrial carcinoma pT1NOMO. A postoperative abscess of the vaginal stump was evacuated. The patient was admitted three years later with a massive vaginal bleeding. Her general appearance and nutritional status were bad. The vaginal bleeding was caused from ruptured varicose pelvic veins secondary to portal hypertension. Neither conservative (vaginal tamponade, infusions) nor operative (laparotomy with an intraabdominal and transvaginal tamponade) therapy was successful. The patient died as a result of severe bleedings. We discuss differential diagnostics and planning therapy.

Transaldolase genes from the cyanobacteria Anabaena variabilis and Synechocystis sp. PCC 6803: comparison with other eubacterial and eukaryotic homologues

We have sequenced and analysed the transaldolase (tal) genes from two cyanobacteria, Anabaena variabilis (ATCC 29413) and Synechocystis sp. PCC 6803, which are filamentous heterocyst-forming and unicellular organisms, respectively. The deduced amino acid sequences of the two cyanobacterial tal genes are 78% identical and are highly homologous to both eubacterial and eukaryotic transaldolases (Escherichia coli, two yeasts, and man) with values ranging from 54 to 60% amino acid identity. In contrast, the transaldolase homologous sequences from the cyanobacterium Nostoc sp. ATCC 29133, from Mycobacterium leprae, and the partial sequence from the higher plant Arabidopsis thaliana have a much lower degree of homology with each other and relative to the sequences mentioned above. These data indicate three different types of transaldolases.

The maize GapC4 promoter confers anaerobic reporter gene expression and shows homology to the maize anthocyanin regulatory locus C1

The cytosolic glyceraldehyde-3-phosphate dehydrogenase (GapC) gene family of maize is differentially expressed in response to anaerobic stress. While GapCl and GapC2 are downregulated, GapC3 and GapC4 are anaerobically induced. We have sequenced and analyzed a 3073 bp promoter fragment of GapC4. The promoter confers anaerobic induction of a reporter gene construct in a transient gene expression system in maize. Deletion analysis of the GapC4 promoter revealed a 270 bp long DNA region required for anaerobic induction. This region contains sequence motifs resembling the cis-acting sequences of the anaerobically induced maize Adh1 and Adh2 genes. Furthermore, the 3073 bp GapC4 promoter fragment displays homology to long terminal repeats of maize retrotransposons and to the 3' region of the maize anthocyanin regulatory locus C1.

CD 44 exon v6 as a predictor of lymphatic metastases in cervical carcinoma--an immunocytochemical study of 94 cases

The relation between expression of several splicing variants of the CD 44 glycoprotein by tumor cells and the increased risk of metastases was discussed recently. By means of an immunocytochemical study (imprint cytology specimens from 94 invasive cervical carcinomas) we have shown a significant correlation between expression of CD 44 v6 and invasion of lymphatic vessels, lymphangiosis carcinomatosa in the primary tumor and the total number of positive pelvic lymph nodes. Expression of CD 44 v6 was not correlated with staging, grading and histological type. CD 44 v6 could therefore be considered as a predictor of lymphatic metastases in cervical carcinoma.

Invasive electrophysiological evaluation of patients with sleep apnoea-associated ventricular asystole-methods and preliminary results

Twelve patients (aged 48 +/- 12 y) with ventricular asystole of >3 s due to complete atrioventricular (AV) block (n = 8), sinoatrial (SA) block or sinus node arrest (n = 3) or both (n = 1) associated with obstructive sleep apnoea underwent invasive electrophysiological evaluation of sinus node function and AV conduction properties before and after administration of atropine (0.02 mg kg-1). Ventricular asystole lasted for 5.9 +/- 2.8 s (range 3.1-13 s). Sinus node function was assessed by measurement of sinus node recovery time, sinoatrial conduction time, and the response of sinus rate to atropine. Parameters of AV-conduction assessment included AH- and HV-intervals, AV- and VA-Wenckebach periods, and effective refractory period of the AV node before and after atropine. Sinus node function was normal in 11 of the 12 study patients and moderately abnormal in 1 patient. AV-nodal function was normal in 8 patients and moderately abnormal in 4 patients. A slightly prolonged HV-interval (59-63 ms) was present in 6 patients. Intra- or infra His block was not observed in any patient. In conclusion, normal or only moderately abnormal electrophysiological findings in patients with sleep apnoea-associated ventricular asystole suggest that a neurally mediated cardioinhibitory reflex may cause ventricular asystole in these patients. This sleep apnoea-triggered 'vasovagal' reflex may unmask pre-existing mild to moderate structural abnormalities of the AV conduction system.

Coronary heart disease and upper airway obstruction

Coronary heart disease (CHD) is a leading cause of death among middle-aged men. In the same age group the spectrum of upper airway obstruction from habitual snoring to obstructive sleep apnoea syndrome (OSAS) is frequent. In several studies snoring was found to be an important risk factor for ischaemic heart disease. The prevalence of OSAS in patients with CHD, profile of risk factors and ventricular arrhythmias was determined in a prospective manner in 78 patients with stenosis of one or more coronary arteries at coronary arterography. OSAS was found in 27 patients (34.6%). Mean respiratory disturbance index (RDI) was 23.9. RDI increased with higher age. No significant differences in both groups could be found in ventricular arrhythmias, left ventricular ejection fraction and risk factors, except hyperuricaemia and adiposity. OSAS is frequent in patients with CHD and may be an additional risk factor besides the known coronary risk factors. Patients with the combination of CHD and OSAS have to be regarded as a group at particular risk because of several interactions between OSAS and coronary haemodynamics. Furthermore the microstructure of sleep in patients with nocturnal myocardial ischaemia is disturbed.

[Examination by image analysis for determining quantitative DNA parameters of serous papillary adenocarcinoma of the endometrium--a single case analysis]

Serous-papillary adenocarcinoma of the endometrium are rare tumors. We describe DNA-parameters of such a tumor. Imprint-cytologies were taken from 6 different tumor sites (myometrial invasion and 5 additional tumor localizations) and subjected to image-cytophotometry in order to determine their DNA-parameters. All histograms showed an aneuploid DNA-pattern. The DNA-malignancy grade (DNA-MG) was 2.21 +/- 0.11 on median and the 5c exceeding rate (5c ER) was 15.37 +/- 4.17 on median. These results and the slight variability of DNA-pattern at the reported serous-papillary adenocarcinoma support the hypothesis of an own entity of this tumor. Additionally, the high values of DNA-MG and 5c ER confirm the well known aggressive behavior of this tumor entity.

Intercomparison of spectral-UV-radiation measurement systems

The results of what is to our knowledge the first intercomparison of seven independent spectroradiometers measuring solar UV irradiances are presented. The intercomparison was carried out in the GSF-Forschungszentrum für Umwelt und Gesundheit, Neuherberg (near Munich, Germany), on 13 July 1990. The spectroradiometric measurements were supplemented by other meteorological, optical, and chemical measurements at the same time. As this day was cloudless, the data can be compared with the measurements taken by Bener in Switzerland in the 1960's and with the results of radiative transfer models. The measured irradiances at noon differed by factors of up to 100. These large differences demonstrate the great difficulties with this type of measurement. Some instrument systems, however, ranged within tolerances of ±10%, thus allowing us to make recommendations for the spectroradiometry of solar UV irradiances.

A new animal model of dopamine supersensitivity using s.c. implantation of haloperidol releasing polymers

Dopamine supersensitivity was induced by either the continuous daily release of 1.0 mg/kg haloperidol from controlled release polymers implanted subcutaneously in rats or by daily bolus injection. In vitro, these polymers were found to release haloperidol for more than 250 days. After implantation in vivo, supersensitivity was quantified by locomotor activity following apomorphine injection and specific [3H]spiroperidol binding to striatal synaptic membranes. Supersensitivity in rats with haloperidol implants was remarkably similar to that evoked by daily drug applications after 3 weeks without producing the detrimental daily sedations, typically seen after bolus administration. Furthermore, no difference in specific binding between both group was seen. A continuous delivery of haloperidol for 8 weeks also resulted in comparable denervation supersensitivity. Controlled release polymers may thus be a superior tool to induce denervation supersensitivity in a gradual, continuous fashion.

[Influence of nCPAP therapy on bradycardic arrhythmias in sleep apnea]

In 5-10% of patients with sleep apnoea, AV conduction block or sinus arrest up to several seconds can be demonstrated. We studied the effect of nCPAP treatment on apnoea-associated heart blocks. 10 consecutive patients (9 m, 1 f) between 28-56 years of age (mean value 43.4 y) were studied. The diagnosis of sleep apnoea and nocturnal heart blocks during the first visit at the outpatient department were the only selection criteria. A standard polysomnography before and during nCPAP was performed. Mean pretreatment RDI was 91/h. Repetitive II degrees and III degrees AV conduction blocks were diagnosed in 2 patients (pts) and sinus arrest of 2 to 11 s in 8 pts at the study without therapy. 89.2% of heart blocks occurred during REM-sleep. In 8 pts a complete reversal of heart blocks could be demonstrated during nCPAP. In 2 pts heart blocks persisted at a reduced number during REM-sleep, mainly during ineffective nCPAP. In 80% of our pts nCPAP leads to a complete reversal of heart blocks. The indication for pacemaker implantation must be established on an individual basis.

[Determination of steroid hormone receptors with the biochemical DCC method in endometrial cancer and tumor margin-endometrium relations to cellular changes and hormone level]

In endometrial carcinoma and the surrounding marginal endometrium from 48 postmenopausal patients, the concentrations and dissociation constants of steroid hormone receptors were studied by the dextran-coated charcoal method (DCC), parallel to ploidy and morphology of tumour cell nuclei, grading, and the hormonal status. The results show, that the proportion of receptor-positive tumours is decreased in an advanced stage of disease. The mean receptor concentrations correlate both with nuclei parameters and the morphological results and reflect the process of dedifferentiation in the tumour centre. The higher receptor concentrations, especially the estradiol receptor concentration observed in the marginal endometrium, and the increased estradiol level in serum, demonstrate a raised tendency to proliferation in this region and could support the hypothesis, that a higher receptor level in adenomatous-hyperplastic tissues participates in tumour genesis. In patients with an advanced stage of the disease, determination of both receptors can yield indications for a purposeful adjuvant hormone therapy (anti-estrogen and/or gestagen), in addition to providing an aid to prognosis.

Mechanical dilatation rather than plaque removal as major mechanism of transluminal coronary extraction atherectomy

Atherectomy with the transluminal extraction endarterectomy catheter (TEC) is a new approach for treatment of coronary artery disease, which continues to undergo FDA investigational studies. The major mechanism of the TEC device should be excision of plaque and its removal due to suction applied through an attached vacuum. We report about the acute results in 24 patients treated with TEC atherectomy in native vessels and the outcome of 18 patients who, until recently, underwent follow-up catheterization after 6 months. The procedure was successful (residual stenosis less than 50%) in 7 of 24 patients with TEC atherectomy alone (29%); 15 of 24 patients (65%) required additional PTCA in order to achieve angiographic success (10 of 24) or to treat total occlusion (2 of 24) or distal embolization (3 of 24) following atherectomy. One TEC attempt failed due to guiding catheter problems, another major complication was a vessel perforation leading to a non-Q wave infarction. The minimal residual diameter after passage of the stenosis (prior to additional PTCA) with the 5.5 Fr catheter (n = 14) was 1.5 +/- 0.2 mm, with the 6 Fr catheter (n = 9) 1.8 +/- 0.4 mm, and 2.2 +/- 0.2 mm using the 7 Fr catheter (n = 10). The histologic findings revealed intimal cells, fibrous tissue, and homogenate with no identifiable tissue in five cases (21%), whereas in 17 patients (72%) light microscopy could only assess blood cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The relation between the results of cytophotometric examination of endometrial carcinoma and clinical course of these disease

We made a prospective cytophotometric study of 48 cases of endometrial carcinoma. Thirty-two (66.7%) of the cases had diploid DNA content and the proportion of non-diploid tumors increased with the staging of tumors, lack of differentiation and depth of myometrial invasion. DNA content (AE), DNA malignancy grade (DNA-MG) and 5c exceeding rate were statistically significant in relation to the clinical course of the disease and the histological grade of differentiation. DNA parameters appear to be especially suitable for the objective assessment of malignancy.

[In-vivo 31P-NMR-spectroscopy in patients with dilated cardiomyopathy]

In vivo 31P-NMR spectra of heart muscle were obtained in 7 patients with dilating cardiomyopathies and in 10 normal subjects, using an ISIS technique with a 1.5 Tesla body scanner (Philips Gyroscan S15) and the results of the two groups were compared. These results were easily reproduced. In patients with cardiomyopathy there was a significant (p < 0.05) reduction of the PCr/ATP ratio as an expression of abnormal energy metabolism. Two patients with mild clinical symptoms and only slightly reduced functional measurements showed no significant changes in the 31P-NMR spectrum. The patients with the largest reduction of the PCr/ATP index also showed the most marked changes in functional measurements. The PCr/ATP ratio (as also suggested by animal experiments) appears to be a suitable non-invasive indicator for the diagnosis and staging of myocardial changes in dilating cardiomyopathies.