[Adjuvant hormonal therapy in lymph node-negative breast carcinoma patients in the postmenopause]

The effect of adjuvant treatment with tamoxifen on recurrence and survival rates was determined in a prospective randomized trial in 98 postmenopausal women (mean age 62.7 [49-77] years) with lymph node-negative breast cancer who had undergone modified radical mastectomy with axillary lymphadenectomy. The tamoxifen group (n = 48) received 10 mg of the drug twice daily for one year. After a mean period of 8 (6-11) years the tamoxifen group had a significantly higher rate of survival without recurrence than the control (no tamoxifen) group (83% vs 61.5%, P = 0.02) and a higher overall survival rate (95% vs 81.9%, P = 0.05). These results indicate that adjuvant tamoxifen favourably influences the prognosis for postmenopausal women with lymph node-negative breast cancer after radical mastectomy with axillary lymphadenectomy.

[Effectiveness of Burch colposuspension in females with recurrent stress incontinence--a urodynamic and ultrasound study]

A collective of 31 women with recurrent stress urinary incontinence was subject to Burch colposuspension. The average time interval between the primary treatment (anterior colporrhaphy) and surgical colposuspension was 5.5 years. All patients underwent clinical, urodynamic and sonographic assessment of incontinence prior to and after surgery. The follow-up examination was performed at an average of 14.5 months after colposuspension according to the method reported by Burch. In 87% of patients, continence was achieved. 90% of patients were able to void without any formation of residual urine in the bladder. In the attempt to optimise the diagnostic and therapeutic procedures pertaining to female incontinence, introitus sonography and urodynamic assessment have proved to be valid adjuvant tools.

[The effectiveness of intravaginal estriol tablet administration in women with urge incontinence]

In postmenopausal patients, stress and urge incontinence often occur as a consequence of oestrogen deficiency. We performed a comparative study in a prospectively randomised and placebo controlled group of women with urge incontinence to investigate different dosages of intravaginally applied oestriol. Clinical and urodynamic parameters were also compared. 15 women (Group I) received 1 mg oestriol applied daily intravaginally over 3 weeks; 15 women (Group II) received a daily dosage of 3 mg and 10 women received a placebo. A complete clinical and urodynamic evaluation was carried out twice at a 4-week interval. The women receiving a daily dose of 3 mg oestriol applied intravaginally demonstrated a significant improvement of the parameters strong desire to void, pollakisuria, and nycturia. No improvement was seen in patients with motoric urge incontinence.

[Comparison of emepronium bromide with intravesical administration of lidocaine gel in women with urge incontinence]

In the treatment of urge incontinence, drug therapy predominates. In a prospective randomised study on treatment of females with motor urge incontinence, intravesically administered lidocaine-gel and oral emepronium bromide were compared using clinical and urodynamic parameters. From 30 patients, 15 women were treated for 3 weeks with repeated intravesical lidocaine gel instillations whilst the other 15 had a peroral emepronium bromide medication. The intravesical lidocaine gel installation proved more efficient compared with peroral emepronium bromide therapy with regard to the parameters of imperative micturition, occurrence of detrusor contractions as well as number of urinary frequencies per diem. Intravesical application of lidocaine-gel is particularly indicated in patients with increased sensitivity against parasympathicolytics and anticholinergics.

[Hypergonadotropic amenorrhea (WHO III) as osteoporosis risk]

In 21 patients, suffering from amenorrhoeic hypergonadotropic ovarian insufficiency (age 27 +/- 3 years [FSH: 43 +/- 10, LH: 40 +/- 8]), the bone density was measured by single-photon densitometry (SPA), before starting a hormonal replacement therapy with oestrogen/progesterone. Every 5 months, the trend in bone density change was measured in all cases. The bone density before hormonal treatment was lower in the WHO III-group (1.36 +/- 0.21 g/cm; 1.09 +/- 0.26 g/cm2) than in the age-matched group (1.57 +/- 0.21 g/cm; 1.28 +/- 0.31 g/cm2). Bone density increased after hormonal therapy (p less than 0.05). These results point to the necessity of hormonal replacement therapy in cases of WHO III.

Urodynamic and radiologic parameters before and after loop surgery for recurrent urinary stress incontinence

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. Forty patients suffering from recurrent stress incontinence underwent a dura-sling operation, i.e. loop surgery. The mean period od incontinence complaints prior to secondary surgery was 2.6 years. Follow-up urodynamic parameters revealed a slight improvement in urethral closure pressure (UCP) as well as significant improvement in functional urethral length and depression quotient. Radiologic investigations before and after sling surgery demonstrated good morphological results (angle beta). One year after surgery, 85% of the women had both clinical and urodynamic continence. Medium-term micturition complaints, however, have to be accepted in some of the patients.

[Results of radioiodine treatment of patients with immunogenic and non-immunogenic hyperthyroidism using different focal doses]

The aim of this study was to check the efficacy of radioiodine (131I) therapy (RIT) in a large number of patients (n = 506) suffering from immunogenic or non-immunogenic hyperthyroidism (Graves' disease, Plummer's disease). Since there is no causal cure for immunogenic hyperthyroidism RIT provides, like all other modalities, only a moderate rate of success which is clearly dose-related. Applying 60 Gy, normal thyroid function can be achieved in only 54% of the cases. A dose of 150 Gy succeeds in 86% of the cases. The solitary decompensated autonomous adenoma (DAA) can be eliminated surgically as well as by RIT with a high degree of success (95%). Contrary to surgery, RIT does not have any noticeable early or late morbidity. The high rate of success of RIT in patients with DAA could be confirmed in two groups with different follow-up periods (16 and 65 months). As expected, the rate of hypothyroidism increased from 11% in the early group to 23% in the late group. Multinodular autonomous adenomas can be eliminated successfully using RIT as well. The concept to apply a dose of 400 Gy to the total functional autonomous tissue as determined by ultrasound yields better results (95%) than 150 Gy to the whole thyroid gland as measured by ultrasound (88%). The rate of hypothyroidism as shown by these results (up to a maximum of 62% after RIT of Graves' disease using 150 Gy) is the lesser evil compared to remaining or recurrent hyperthyroidism since these patients can be treated with thyroid hormones without problems.

[Joint pain in pre- and postmenopausal arthropathia climacterica]

The menopausal syndrome consists of a variety of psychic and physical signs of different intensity. At our outpatient department for climacteric complaints and osteoporosis prevention (1. Dept. of Gynecol. and Obstetrics, Vienna) 820 women, who have been consulting this department for the first time because of prevailing complaints or prophylactic reasons, were registered in the year 1986. In the course of this work we paid particular attention to the symptom "pain in a joint" as a sign of the beginning climacteric period. Referring to our patient population we tried to analyse epidemiologically the frequency and the degree of severity of menopausal arthritic pain as well as the therapeutical response to a hormone substitution therapy. To what extent an endocrinologic explanation can be found and which facts let us assume such a statement, we tried to demonstrate in the discussion.

Influence of oral contraceptive use on bone density in climacteric women

The aim of the study was to investigate the influence of long-term administration of oral contraceptives on bone density in climacteric women. The existence of a correlation between long-term use and bone density was confirmed.

Chromatin association and DNA binding properties of the c-fos proto-oncogene product

As a first step in the analysis of the molecular function of the nuclear c-fos proto-oncogene product we have studied its subnuclear localization in serum-stimulated mouse fibroblasts where it forms a non-covalent, apparently monodisperse complex with another nuclear protein, p39. The c-fos/p39 complex is almost quantitatively released from intact nuclei by DNasel or micrococcus nuclease treatment under conditions where only a minor fraction of DNA and nuclear proteins is released. In gel filtration experiments, c-fos/p39 comigrates with chromatin and seems to be associated with regions of increased DNasel accessibility. c-fos/p39 is bound to chromatin by electrostatic forces of moderate strength since greater than 90% of the complex can be eluted from nuclei at 0.4 M NaCl. In vitro, the c-fos/p39 complex in nuclear extracts binds to double- and single-stranded calf thymus DNA, suggesting that the association of c-fos/p39 with chromatin is at least in part due to its interaction with DNA. In agreement with this conclusion, c-fos/p39 is released from nuclei by incubation with tRNA, presumably due to competition for binding sites. Our observations are compatible with the hypothesis that c-fos may play a role in the regulation of gene expression.