Fertilisation failure after intracytoplasmic sperm injection is not associated with sperm aneuploidy of a globozoospermic patient

The objective of this study was to determine the aneuploidy rate in spermatozoa from a globozoospermic patient who underwent three unsuccessful intracytoplasmic sperm injection (ICSI) treatment cycles together with his wife. The aneuploidy rates of chromosomes 13, 18, 21, X and Y as well as the diploidy rate in the spermatozoa of this man were evaluated by fluorescence in situ hybridisation to clarify if chromosomal aneuploidy could be a cause for the low fertilisation rate observed in this case. In the spermatozoa of our patient no increase in aneuploidy rates was found for the tested chromosomes (0.0% disomies of chromosomes 13, 18 and 21 with a diploidy rate of 0.6%; X/Y missegregation: 0.6%) indicating that the ICSI outcome of the couple was not impaired by sperm aneuploidy of the globozoospermic man.

Interphase M-FISH applications using commercial probes in prenatal and PGD diagnostics

Early, rapid and reliable diagnosis is of first priority in prenatal medicine. The combination of specific sonographic markers (e.g. nuchal translucency) and biochemical parameters in maternal serum (e.g. free beta-human chorionic gonadotropin, pregnancy-associated plasma protein A), has already dramatically improved the sensitivity of non-invasive first trimester risk screening in pregnancy. In invasive prenatal diagnosis, in addition to well-established chorionic villi short-term culture, interphase multi-colour-fluorescence in situ hybridisation (M-FISH) on uncultured amnion cells has become a reliable tool for the rapid detection of fetal aneuploidies. Interphase M-FISH applications have enabled the diagnosis of selected chromosomal abnormalities in single cells and, therefore, have also become an important diagnostic tool for preimplantation diagnosis (PGD). The development of commercially available probe sets, in particular, has led to a broad use of interphase M-FISH in prenatal and PGD diagnosis.

Multi-locus (ML)-FISH is a reliable tool for nondisjunction studies in human oocytes

In the present study, we developed a fluorescence in situ hybridization (FISH) strategy, which allows a reliable determination of the chromatid number of specific chromosomes in mature human oocytes. 168 unfertilized oocytes were analyzed by dual-color FISH with two direct-labeled locus-specific DNA probes for chromosome 13 and 21. To exclude FISH failures, metaphases with abnormal signal patterns were reanalyzed by multi-locus-FISH (ML-FISH) for chromosome 13 and 21. Following dual-color FISH, abnormal signal patterns were detected in 21 out of 108 metaphases (19.4%). 17 of these metaphases were reanalyzed by ML-FISH. In contrast to the first FISH, seven metaphases showed normal signal patterns after rehybridization, whereas ten metaphases remained abnormal. Out of these real aneuploid metaphases, five showed gain or loss of a single signal (= chromatid), two showed missing double signals (= chromosome) and three showed both. In conclusion, locus-specific FISH probes facilitate differentiation between first meiotic nondisjunction of whole chromosomes and prematurely divided chromatids. Moreover, simultaneous hybridization with a second locus-specific probe on the same chromatid (ML-FISH) helps to differentiate between FISH failures and real meiotic division errors and therefore, allows a more reliable analysis of aneuploidies in human oocytes.

[Organ preservation in advanced laryngeal and hypopharyngeal carcinoma by primary radiochemotherapy. Results of a multicenter phase II study]

INTRODUCTION

Regarding the promising results of international trials we conducted the first German prospective multicentre phase II trial for organ preservation with primary simultaneous chemoradiation in advanced laryngeal and hypopharyngeal cancer.

PATIENTS AND METHODS

28 of 30 recruited patients suffering from stage II and III (UICC) laryngeal and hypopharyngeal cancer were treated with primary simultaneous chemoradiation within an organ preservation program and monitored in follow-up of one year. Exclusion criteria included tumor infiltration of the laryngeal cartilage, bilateral neck nodes (N2c) and need for flap reconstruction in case of laryngectomy. The protocol included an accelerated concomitant boost chemoradiation (66 Gy) with Carboplatinum (70 mg/m2 1st and 5th week) and a restaging procedure one month after therapy. In case of residual disease, salvage laryngectomy and/or neck dissection were performed.

RESULTS

After follow-up of one year 20 of 28 patients (71%) were presented with stable complete remission and functionally preserved larynx. Of these 20 patients 3 developed pulmonary metastases, 1 secondary primary carcinoma of the lung and 3 neck metastases which needed neck dissections. The other patients showed in 4 cases relapsing tumor which was indicated for laryngectomy. One patient needed tracheotomy because of persisting edema and 2 patients died due to tumor progress. One patient died after complications due to salvage surgery.

CONCLUSION

The organ preservation protocol was feasible with well tolerated early toxicity. Problems of screening for recurrent disease, salvage surgery and late toxicity should be noted and pronounced in patient information. Further studies should focus on the improvement of patient selection which could be realized by induction Chemotherapy (using new components like taxan) and/or use of prediction factors such as tumor volume and hemoglobin levels.

[Prognostic value of hemoglobin level for primary radiochemotherapy of head-neck carcinomas]

The pretherapeutic hemoglobin level (Hb) has been postulated to constitute a prognostic marker for outcome after primary chemoradiation of patients with advanced cancer of the head and neck. However, this hypothesis has not been tested systematically in large study samples. In the years 1992-1997, 125 patients with advanced head and neck cancer (stages III/IV UICC) were treated with primary chemoradiation in two different prospective multicentric trials, 62 patients in trial A (phase II, 1992-1995), and 63 in trial B (phase III, 1995-1997). Beside initial Hb, other pretherapeutic parameters with potential prognostic relevance were assessed and correlated with clinical outcome after 43-months follow-up: total tumor volume (TTV; calculated in initial CT scans), tumor oxygenation (polarographic measurements with Eppendorf histography), TNM, tumor localization, age, and performance status. The evaluation of the clinical end points (progression-free and overall survival and local tumor control) revealed that Hb and TTV were independent parameters with strong predictive character of outcome after primary chemoradiation in both trials (n = 125). Bivariate analysis showed < median (13.5 g/dl) a hazard ratio of 2.1 (P = 0.002) for Hb; and > median (98 ml) a Hazard ratio of 2.0 (P = 0.006) for TTV. Severe anemia (Hb < 10 g/dl) was an adverse factor in three patients. Hypoxia was associated with poorer initial therapeutical response but was not predictive of clinical outcome. Furthermore, tumor oxygenation showed no correlation with Hb. The other parameters examined failed to show prognostic significance. Our results indicate a high prognostic value of initial Hb for outcome after primary chemoradiation in advanced head and neck cancer and imply a therapeutic benefit of Hb substitution or erythropoietin administration. We propose to test this in randomized clinical trials.

2[F]-fluoro-2-deoxy-D-glucose positron emission tomography is a sensitive tool for the detection of occult primary cancer (carcinoma of unknown primary syndrome) with head and neck lymph node manifestation

BACKGROUND

The neck lymph nodes are a common site of metastases from carcinoma of unknown primary (CUP syndrome). 2[(18) F]-fluoro-2-deoxy-D-glucose positron emission tomography (18-FDG-PET) has been shown to be a sensitive tool for detecting primary malignant lesions as well as metastatic spread. We have prospectively investigated the sensitivity of 18-FDG-PET in detecting occult primary carcinomas with manifestation in the head and neck lymph nodes.

METHODS

From May 1994 to July 1998, in 723 patients a cancer of the head and neck was diagnosed at the University of Cologne ENT outpatient clinic. The routinely performed staging procedures were chest radiography; full blood count; cervical and liver ultrasound; endoscopy of the nasopharynx, oropharynx, hypopharynx, larynx, and esophagus; and laboratory analyses. After the staging workup, in 27 of 723 patients (3.7%) CUP syndrome had to be presumed because the primary cancer could not be detected. In these patients 18-FDG-PET was performed, and images were reconstructed with a transmission-emission fusion technique.

RESULTS

In 7 of 27 patients (26%) 18-FDG-PET revealed an unknown primary: in 2 a bronchial carcinoma, in 2 a nasopharyngeal carcinoma, in 1 a squamous cell carcinoma of the parotid gland, in 1 a squamous cell carcinoma of the hypopharynx, and in 1 a carcinoma of the tonsil. In 4 of 7 patients the occult primary tumor was removed surgically. In 8 of 27 patients therapeutic strategy was changed as a result of the 18-FDG-PET findings.

CONCLUSION

18-FDG-PET should be performed in all patients with CUP syndrome after conventional diagnostic workup fails to identify the primary.

[Infection of deep soft tissues of the neck in intravenous drug abuse]

BACKGROUND

Despite the availability of antibiotics deep neck space infections with anaerobic germs (Ludwig's angina) still carry the potential for significant morbidity and mortality with delayed treatment. Usually, odontogenic infections with involvement of the submandibular space are the source of deep neck space infections in adults, whereas in the pediatric population the most common cause is acute tonsillitis with involvement of the peritonsillar space. During the second half of this century intravenous drug abusers appeared as a new group of patients at risk for deep neck space infections. When peripheral veins sclerosis the addicts feel it necessary to either inject subcutaneously or use the major vessels of the neck and groin. Intravenous drug abusers injecting the major vessels of the neck risk delayed diagnosis because of dissimulation of their injection practices. Dangerous complications of deep neck space infections may be the result.

CASE

We report a clinical case with delayed diagnosis and fatal outcome.

CONCLUSION

Intravenous drug abuse is a rare cause for deep neck space infections but should be considered when swelling of the neck soft tissue of uncertain cause is presented. The search for the diagnose should not keep from taking quick therapeutic steps.

[Results of a prospective randomized trial with induction chemotherapy for cancer of the oral cavity and tonsils]

Although induction chemotherapy administered prior to local therapy produces encouraging initial response rates in head and neck cancer, randomized studies have failed to demonstrate an improvement in survival rates. All randomized studies included only patients with advanced stage III and IV disease. In our opinion, this is the main reason for the low rate of complete responses demonstrated in the randomized trials (maximum 18%). Frei et al. estimate that a 40%-50% complete response rate is necessary before improved survival rates are seen. To date, such complete response rates with induction chemotherapy have only been attainable in resectable T2-T3, N0-N2 disease. Therefore, we initiated a prospective randomized trial including only patients with the mentioned disease stages. Patients (pts) were randomized to receive either induction chemotherapy with three cycles of carboplatin/5-FU prior to surgery and radiotherapy (arm A, 70 pts) or standard treatment with surgery and radiotherapy (arm B, 74 pts). Patients were classified according to primary tumour site and neck disease. The observed remission rate after chemotherapy confirmed the primary estimated rate for this subgroup of patients with head and neck cancer (CR: 43%, PR: 37%, NR: 15%, PD: 5%). After a follow-up of 12-96 months overall survival was 58% in arm A and 45% in arm B (n.s.). Disease-free survival in arm A (61%) is statistically significantly better than in arm B (43%, P=0. 03). Therefore, we recommend further controlled trials to investigate the role of induction chemotherapy in patients with primary resectable carcinomas of the oral cavity and tonsils and stage T2-T3 and N0-N2 disease prior to surgery.

Molecular biological characterization of phosphodiesterase 3A from human corpus cavernosum

The hydrolysis of the second messenger cyclic AMP (cAMP) by phosphodiesterase 3 (PDE3) is known to play an important regulatory role in the context of relaxation of cavernous smooth muscle of the penis. Thus, we investigated the PDE3A isoform from penile cavernous tissues of male patients with and without symptoms of erectile dysfunction at the molecular biological level. As revealed by reverse transcriptase polymerase chain reaction, of all tissues of the urogenital tract analyzed the expression of the PDE3A gene was highest in the corpus cavernosum. However, significant differences in the levels of gene expression were not found between the two subgroups of patients. Also, the determined nucleotide sequences of the cloned penile PDE3A cDNAs of all patients were absolutely identical. Surprisingly, some deviations could be detected in the cDNA sequences of PDE3A from human myocard and platelets. The data obtained indicate that neither the expression levels nor the sequence deviations of PDE3A are the main reasons for erectile dysfunction in men.

[Possibilities for gathering environmental information for training environmental medicine specialists]

In the context of continuing medical education, colleagues frequently face new professional topics. Advanced questions have to be clarified often to realize new skills. Beside the "conservative" information options like journals, literature searches in libraries and questioning colleagues, the "progressive" information procurement via CD ROM or the Internet is a comprehensive option to clarify certain questions quickly.

[Value of monoclonal antibodies (PC 10, MIB1, p53 and LeuM 1) for assessing the prognosis of patients with squamous epithelial carcinoma of the larynx after partial laser resection]

An immunohistochemical analysis with monoclonal antibodies against Ki-67 (MIB 1), PCNA (PC10), p53 and Lewis X antigen was performed on 47 squamous carcinomas of the larynx after partial laser resection. Ki-67 index and expression of Lewis X antigen correlated significantly with both tumor recurrence rate and tumor-free interval. A much weaker relationship was found for the expression of proliferating cell nuclear antigen (PCNA), and no correlation existed with p53 expression. In conclusion, examination of Ki-67 and Lewis X antigen is thought to provide useful prognostic information concerning laser-resectable squamous carcinomas of the larynx.

Accelerated split-course radiation and simultaneous chemotherapy in patients with unresectable head and neck-cancer

Forty-nine patients with unresectable squamous cell carcinomas of the head and neck were treated with accelerated radiotherapy (2 x 2.1 Gy/day, day 1-4 in week 1,2,5 and 6, total dose of 67.2 Gy) and simultaneous carboplatin (50 Mg/M2/ treatment day). Mucositis (21% grade 3 and 4, WHO) and leukopenia (40% grade 3 and 8% grade 4, WHO) were the most important side effects but did not limit the treatment schedule. The response rate was: 46.5% CR (20 pts), 46.5% PR (20 pts), 5% NC (2 pts) and 2% PD (1 pt). After three years overall survival was 35% (median 14 month) and in complete responders disease-free survival was 52%. Our results indicate that combined accelerated radio-chemotherapy might improve the poor results achieved with conventional radiotherapy or sequential chemo-radiotherapy in this difficult patient population. Further studies are neccessary to clarify whether modified radiotherapy or simultaneous chemotherapy or the combination of both are the reason for the improved treatment results.

[Tuberculosis of the smaller joints]

Eighty-nine patients with tuberculosis of joints in the hands or feet have been examined. There has been a change in the peak incidence from adolescence to adult life. The high number of incorrect diagnoses was remarkable (45% in our own patients). A previous tuberculous infection was found in 40% of the patients. Osteoporosis, or bone atrophy, are important radiological signs for the early diagnosis and follow-up of articular tuberculosis. The later phase is characterised by narrowing of joint spaces. Later still there is destruction of subchondral lamellae and fusion of the carpal and tarsal bones, resulting in changes of shape and position.

[Pulmonary tuberculosis today-revisited (author's transl)]

The diagnosis and differential diagnosis of pulmonary tuberculosis--in spite of its general decline in frequency--remains an important task, even today. There are certain types of opacification which should make one think of TB. A pulmonary nodule--with or without hilar involvement--in an adult may represent primary TB. Postprimary disease is usually located in the first or second lung segment, occasionally also in the sixth. Abnormal findings in the apices are usually tuberculous in origin. Bilateral foci in both upper lobes with similar or identical opacification patterns are especially typical of tuberculosis. Without treatment, there is apico-caudal progression. With tuberculostatic therapy, there usually is rapid regression with relative little scar formation. Residuals of cavities can present as a ring like shadow. Tests for TB-bacteria are usually negative in these cases. Circumscribed older lung lesions in asymptomatic healthy appearing patients mandate supervision of these patients to detect reactivation of the disease, which occurs fairly frequent and to prevent the infection of others.

[The significance of arthrography and arthroscopy in the diagnosis of meniscus injury--a comparative study (author's transl)]

The article reports on 364 double-contrast arthrographics and 185 arthroscopies. The results obtained in 126 patients in whom both arthrography and arthroscopy had been conducted, were compared. It became evident that arthrography is of high informative value in the diagnosis of lesions of the meniscus, so that preference may well be given to this method in non-specific knee-joint complaints where meniscopathy is suspected. Arthroscopies are indicated in cases of clinico-arthrographic doubt. Trial arthrotomy for clarifying doubtful meniscus lesions without previous exploitation of all arthrographic/arthroscopic possibilities is no longer justified and should be abandoned. Arthroscopy is definitely superior to arthrography in the diagnosis of, in particular, cartilage structures, of the synovia and of the retropatellar space. It is here where arthrography has its narrow limitations--now and in the future--for methodical reasons.

[The subphrenic abscess--possibilities and problems of ultrasound diagnosis (author's transl)]

The article reports on 37 patients subjected to sonographic examination because of the clinically suspected diagnosis of a "subphrenic abscess". In 7 of these patients, the diagnosis "subphrenic abscess" was arrived at via sonographic examination, and was confirmed in 6 cases by surgery and in one case by postmortem examination. The importance of ultrasound diagnosis for early identification of the subphrenic abscess is discussed and the high rate of accuracy is underlined. The author emphasises that even discreet x-ray film symptoms should prompt immediate ultrasonic examination.

[Sonography in emergency diagnosis of the abdomen (author's transl)]

The article reports on 150 patients, 86 men and 64 women, aged between 16 and 90 years, who were subjected to sonographic examination directly after they had been admitted as emergency cases. In the group of patients under examination, the clinical disease pattern of acute upper abdominal complaints ranked first, followed (in the rate of incidence) by abdominal trauma and acute metabolic disease. In more than 25 % of the cases the decisive diagnosis was made on the basis of sonography only, so that there was no delay in deciding whether treatment should be initiated or whether the diagnosis required further differentiation. In another over 20 % of the cases ultrasound diagnosis contributed quite substantially towards arriving at the final diagnosis. The number of failures or unsuccessful examinations was about 2 % in each group. The rapid, mobile and risk-free use of sonography is emphasised. The results allow the conclusion that the share of ultrasound in the diagnosis of acutely and severely diseased patients should be increased and that sonography should in fact be placed first and foremost, as far as possible, among the diagnostic tools.

[Roentgenological diagnosis of the functioning of the cervical spine (author's transl)]

Basing on literature and 230 own functional examinations of the cervical spine, the author reports on a roentgenological method which satisfies practical requirements. In patients with degenerative and post-traumatic changes, the extent and localisation of the disorders of function and structure of the vertebrae can be determined by this method, enabling discovery of functional disorders in a large number of patients with clinical cervical spine syndrome. X-ray functional testing is shown to be a necessary complement to conventional x-ray diagnosis and clinical examination.

Early X-ray detection of colonic and rectal tumours in European hamsters

Three groups of European hamster (EH) (Cricetus cricetus L.) were treated subcutaneously every two weeks for life with 1/10 or 1/20 LD50 DMH, while two other groups served as controls. Twelve weeks after commencement of treatment, radiological examinations of the colon and rectum were begun. The double contrast method was used. In this way it was possible to detect the earliest neoplastic alteration to take place in the above sites. This occurred in the 26th treatment week and was diagnosed as an adenocarcinoma. The technique used is simple, as well as being suitable for large numbers of animals. In addition, it allows for early experimental analysis of results in respect to latency period, growth rate, incidence and location of tumours.

[Radiculo-tomography for lumbosacral myelography (author's transl)]

The use of tomography can increase the value of lumbosacral myelography in certain circumstances. Post mortem studies have resulted in standardisation of the examination, which will combine optimal diagnostic information with the least amount of effort and with an acceptable amount of stress on the patient. 110 tomographic examinations were performed amongst 680 lumbosacral myelograms (Dimer X). On the basis of this experience, the value of this procedure is illustrated from various points of view and its indications are discussed.

X-ray enlargement modified for use in experimental animal science

The primary enlarged x-ray image is produced by a reduction of the focal-film-distance to 80 cm at a given focal size of 0-15 mm. The advantages of this technique as compared to conventional x-ray methods are exemplified with x-ray images from the shoulder joint of a European hamster, a pseudoarthrosis in the foreleg of a beagle, and a renovasography of a rat. The principles of the technique and its significance for investigations using small laboratory animals are discussed.

[Radiologic diagnosis of diseases of the salivary glands (author's transl)]

Sialography of the major salivary glands is simple and without risk. Radiologic changes in their ducts permit certain differentiation between infective and malignant processes. Sialography determines further diagnostic and therapeutic action.

Diagnosis of experimentally induced bronchogenic tumours in the european hamster with bronchographs

Four groups of European hamsters were treated subcutaneously once weekly for life with 1/20 or 1/40 the diethylnitrosamine LD 50. Three animals from each treatment group and the two control groups were examined every three weeks by means of bronchographic technique. In four of the animals the bronchograms showed early neoplastic alterations of the bronchial system. The results demonstrate that bronchography is a suitable method for the diagnosis of bronchogenic tumours in the European hamster and that it also allows for the detection of displacing neoplasms of non-bronchogenic origin in the region of the tracheal bifurcation.

Radiological detection and sequential observation of experimentally induced bladder tumours in the European hamster

FOUR GROUPS OF EUROPEAN HAMSTERS (STRAIN MHH: EPH) were treated subcutaneously once weekly for life with 1/20 or 1/40 the LD(50) of DBN while another 2 groups served as controls. Three animals of each group were x-rayed every 2 weeks after i.v. injection of the contrast agent Urographin. By means of cystograms tumours of the urinary bladder were detected between the 20th and 26th weeks after beginning treatment when they had reached a diameter of 1-2 mm; their development was subsequently observed by periodical x-ray examinations. The technique described is simple and provides a valuable means for obtaining additional in vivo information concerning latency period, growth rate and identity of experimentally induced primary urinary bladder tumours in the European hamster.