[The "other induction"--experiences and consequences in 281 deliveries following intravaginal administration of PGE2 tablets]

186 patients have been included prospectively in a study, aimed at analysing the course of birth after induction with 3 mg PGE2-tablets given intravaginally. These data are compared with those gained from a retrospective analysis of 95 patients using a dose of 2 mg. The total of the births within our clinic in 1986/87 functions as controls. Although in every case there has been an urgent need for the termination of pregnancy and there have been also unfavourable cervix findings in the 3 mg group, no differences could be observed in comparison to the control group concerning duration of cervical dilatation and expulsion, as well as foetal outcome parameters. When comparing the 2 mg and 3 mg groups, a certain superiority of the 3 mg dosage could be noted, leading to the opinion, that trial dosages of less than 3 mg should be abandoned. C-section rate was lowest and spontaneous birth rate was highest in the 3 mg group as compared to the 2 mg and the control groups. Permanent CTG-monitoring was not necessary. CTG-controls after 2 and 6 hours proved to be sufficient. Uterine hyperstimulation occurred in 2.1% of cases in both groups. In every case, prompt antagonization by means of high dose betamimetic therapy could be achieved. Due to reducing maternal and foetal side effects, the maximal mobility of the mother after tablet application, as well as, for the smooth congruence of cervical ripening and labour induction, the clinical use of the 3 mg tablet is a modern alternative to the classic oxytocin induction.

[New aspects of radiologic pelvimetry. Digital image intensification radiography: preliminary results of validation possibilities and results in various types of pelvic disproportion]

Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Ovarian carcinoma: increase in clinical validity by simultaneous determination of SRA and CA 125

Ovarian carcinomas are distinguished by their polyclonality, i.e., heterogeneity and polymorphism of their tissue. There is no marker available complying with the clinical demands in the case of ovarian carcinoma regarding satisfactory sensitivity and specificity. Therefore, we have simultaneously determined two entirely distinct tumor markers, serum ribonuclease activity (SRA) and cancer antigen 125 (CA 125), recommended in the literature with respect to ovarian carcinoma. After evaluation by logistic regression analysis, we found a specificity of 93% together with a sensitivity of 97% for the simultaneous determination of SRA and CA 125 (37 ovarian carcinomas, 11 cases without pathological findings after treatment, 11 benign tumors of the ovary, 61 controls). The patients are not exposed to increased stress by this simultaneous determination method compared to the determination of a single marker. The increased clinical validity justifies the recommendation of routine simultaneous determinations of SRA and CA 125 for diagnosis and monitoring of patients with ovarian carcinoma.

[New developments in the area of markers in diagnosis and monitoring of ovarian cancer]

The diagnostic and prognostic prediction of ovarian carcinoma can be substantially improved by combining serological markers synchronized with radiological and morphological methods. The validity of the following markers was investigated in a prospective trial between 1977 and 1983: CEA, TPA, SP-1, SP-3, alpha-1-antitrypsin, alpha-2-macroglobulin, c-reactive protein. The results were correlated with those of the CA 12-5 determination. Pre-operatively, ovarian carcinoma was indicated by CA 12-5 (93.7%), sialyl transferase (65.6%), TPA (53.1%), CEA (28.1%). These markers would appear suitable to control the clinical course.

[Metastatic breast cancer with involvement of the bone marrow, uterus and ovaries. A case report on diagnostic and therapeutic procedures]

The article reports on a clinically unusual case of a patient with carcinoma of the breast. The "initial sign" of the disease was relapsed hypermenorrhoic permanent bleeding with severe bleeding anaemia caused by a metastatic growth in the uterus. Surgery or cytostatic treatment did not seem possible at the outset, because thrombocytopenia (21,000/nl) progressed rapidly, associated with disseminated bone marrow metastases. The diagnostic and therapeutic procedure is described and discussed.

[Diagnostic value of increased lactate dehydrogenase activity in vaginal secretions for the early detection of diseases requiring treatment of the female genitals and breast]

The Diagnostic Validity of Enhanced Lactate Dehydrogenase Activity in the Vaginal Secretion for Early Diagnosis of Diseases of the Female Genitals and the Mamma in Need of Treatment. An impregnated hygiene tampon (Gynaegnost) was used, which by a colour reaction permits the determination of augmented activity of lactate dehydrogenase (LDH) in vaginal secretion. The diagnostic validity of the results of the findings by this method in the detection of diseases of the female genitals and the mamma needing treatment was examined in two clinical diagnostic studies. The first study including 486 patients chiefly suffering from manifest carcinoma was aimed at solving a deliberately limited question. In patients with carcinoma stages I to IV of the most important genital locations augmented LDH-activity (correct positive results) was found in about 90%. A second study comprised 1955 women entering into outpatient gynaecological services for preventive examination; the definition of this series was difficult. Three categories of diagnostic groups can be determined by the results of this study. In the first category with the most important subgroup "routine examination without specification of a pathological finding" less than 20% "false" positive test results by the indicator were observed. A second category with inflammatory diseases (colpitis, endometritis) showed positive results in about one-third of the examinations. The third category comprised a minor number of malignant tumors roughly with a percentage of positive results corresponding to that of the first study. Augmented LDH activity in vaginal secretion is a diagnostic criterion which detects not only cancer; it is similar to the test of occult blood in faeces.(ABSTRACT TRUNCATED AT 250 WORDS)

Ein neuer LH-RIA-Schnelltest zur Ermittlung des LH-Peaks im Serum

A highly sensitive, easy to operate LH-RIA rapid test was developed by changing the incubation period and temperature and by reducing the standard curve to three measurement data, using commercially available reagents. The results obtained by means of the LH-RIA rapid test correlate most loosely with those of a conventional 5-hour LH-RIA. The new LH-RIA rapid test is ideally suited for LH peak search at short intervals for exact determination of the time of ovulation as part of in-vitro fertilisation or insemination.

Reduction of the immunosuppressive action of chemotherapeutics in patients with mammary carcinoma by Azimexon

Patients treated by aggressive cytostatic treatment exhibit marked deficiencies in cell-mediated immunity. Our investigations were performed in order to find out whether these immunosuppressive effects could be diminished by supportive treatment with the new synthetic immunomodulating compound BM 12.531, INN: AZIMEXONE. After inducing remission in ten patients with metastasizing breast cancer by a combination chemotherapy given for about one year, leucocytes, T- and B-lymphocytes and reactivity of peripheral lymphocytes to different mitogens were determined at weekly intervals before (8 X), during (8 X while on 100 mg i.v. weekly, then 4 X while on 400 mg i.v. weekly) and after (4 X) treatment with AZIMEXONE. Chemotherapy-induced immunosuppression could be markedly diminished during the administration of AZIMEXONE. A significant increase in the peripheral leucocyte count and mitogen-induced lymphocyte transformation could be achieved without any marked influence on the percentages of T- and B-cells. No severe side-effects of AZIMEXONE were observed.

[Chemo-(hormonal)-therapy of advanced ovarian neoplasms in FIGO stages III and IV. Prospective SAKK-study 20/71]

From 1971 to 1974 89 patients with advanced ovarian cancer (FIGO-stage III-IV), admitted to seven centers of the Swiss Group for Clinical Cancer Research (SAKK), were randomly allocated to three different treatment schedules: cyclophosphamide (CYT) alone or CYT in combination with either medroxyprogesterone acetate (GEST) or 5-fluorouracil (FU). Results in 71 evaluable patients (according to standardized group criterial) were as follows: 1. The overall remission rate was 48% (34 out of 71 patients) with no clear-cut statistical difference between the three treatment schedules but a firm trend towards higher remission rate with CYT + FU (58% as compared to 42% with CYT alone). 2. The scheduled "second-look" operations were performed in only 5 of 34 patients clinically judged to respond to therapy (PR), and does not allow objective surgical monitoring of therapeutic effects intraabdominally. 3. The median remission duration varied from 3 months (CYT alone) to 6 months (CYT + FU or CYT + GEST), again with only marginal statistical differences. 4. With regard to survival from initiation of chemotherapy, no treatment regimen was superior to another. The median survival ranged from 6.6 months (CYT) to 10.3 months (CYT + GEST). Patients responding to chemo-(hormone) therapy (CR + PR + NC) showed a significant prolongation of survival as compared to those with initial disease progression: median survival in "responders" was 11 months and in "non-responders" 2.9 months. A small group of 8-10% of all treated patients has survived in documented tumor remission for 4 years and more. 5. Toxicity was moderate and consisted mainly of mild temporary hematologic depression, tolerable nausea and transient alopecia, with equal distribution in the three treatment regimens. Hemorrhagic cystitis due to CYT was observed only in 3 cases. 6. Progress in remission induction and duration, as well as survival in advanced ovarian cancer, seems to depend on the inclusion of new effective agents (such as adriamycin, hexamethylmelamine and cisplatinum) and, most probably, on significantly more intensive treatment.

[Adjuvant chemotherapy in breast neoplasms. Clinical and immunologic results]

After radical mastectomy and postoperative radiotherapy 56 patients with loco-regional breast cancer and positive lymph nodes and/or tumor size over 2 cm in diameter were treated by a "mild" adjuvant chemotherapy: Cyclophosphamide 150 mg p.o./day + Methotrexate 7,5 mg on three consecutive days p.o./week. The study was started on July 1st 1975, duration of treatment was planned for two years/patient. At the time of evaluation (May 1st 1979) 21 pre- and 35 postmenopausal patients were under study. 7 patients (12,5%) recurred within 6-36 months after the beginning of chemotherapy. Two women died after 20 resp. 36 months. Median time of treatment was 19 months. Chemotherapy caused very mild toxicity and was well tolerated. Patients under adjuvant chemotherapy developed only a transitory depression of B- and T-cells as well as mitogen-induced lymphocyte stimulation whereas patients under polychemotherapy showed a marked depression of these immunological markers.

[Monitoring the immune status of breast cancer patients under adjuvant chemotherapy and polychemotherapy]

The effects of various combinations of chemotherapy on the immunological status of breast cancer patients were investigated. The proportion of T cells and B cells in the peripheral blood of the patients were followed and the reactivity of lymphocytes to the mitogen phytohemagglutinin (PHA) was determined. During observation periods of 6 months it was found that patients under adjuvant chemotherapy developed only a transitory depression of B cells and T cells as well as of PHA-induced lymphocyte stimulation. However, patients under polychemotherapy showed a marked depression of these immunological markers and functions during the whole observation period. The possibility of an improved monitoring of chemotherapy in cancer patients by observation of these immunological parameters is discussed.

[Electrophoresis mobility inhibition test (emt) in immunological early diagnosis of gynaecological malignomas (author's transl)]

The electrophoresis mobility inhibition test (EMT) was employed in the examination of a total of 74 woman patients with various gynaecological malignomas, 50 women with non-malignant diseases and 41 healthy female controls. In the group of patients with malignoma, 78.4% of the test results agreed with the histological diagnosis, 21.6% of the results were false negative. In the group of patients with benign diseases, 78.0% of the test results were correct, whereas 22.0% were false-positive. One false-positive test result was seen among the healthy controls. Extensive tumour growth, chronic infections and virus diseases seem to falsify the test result. Significance, perspectives and limitations of this test system within the framework of tumour diagnosis, are discussed.