[Cholesteatoma recurrences caused by intraoperative cell seeding? Contact endoscopic and cytologic studies]. / Intraoperative Zellverstreuung als Ursache für Cholesteatomrezidive? Kontaktendoskopische und zytologische Untersuchungen1.

BACKGROUND: The high rate of recurrences of cholesteatomas after surgery is mostly caused by insufficient removal of matrix. Another factor may be intraoperative scattering of matrix cells e. g. with the running burr, which later may become the origin of new cholesteatoma growth. In this paper we tried to visualize these cells for gaining further informations. PATIENTS AND METHODS: In 10 patients intraoperative contact endoscopy of the cholesteatoma was carried out during mastoidectomy. After intravital staining with methylene blue the very superficial tissue layers can directly be considered via a contacting endoscope. In addition, sucked-off rinsing fluid was cytologically examined for epithelial cells. RESULTS: Both investigations show only very rare vital squamous cells - besides other cells like or ciliated cells and foreign body giant cells. DISCUSSION AND CONCLUSIONS: Inspite of their small number, these squamous cells in principle could cause dispersed growth of cholesteatoma. However, this seems to be much less significant than the assumption of matrix left behind intraoperatively. The danger of dispersed cell growth can further be diminished by adequate operating techniques with sufficient rinsing, smoothing the bony cavity walls and avoiding blind corners.

[Carbamazepine and vigabatrin in epileptic pregnant woman and side effects in the newborn infant]. / Carbamazépine et vigabatrin chez la femme enceinte épileptique et effets secondaires chez le nouveau-né.

BACKGROUND: Carbamazepine (Tegretol) is frequently prescribed to pregnant epileptic women. Various congenital malformations constitute the most described side-effects in their newborns. CASE REPORTS: Case 1. Esteban was born by caesarean section at 39 weeks of gestation, weighing 3,860 g. His Apgar score was 8, 9, 10 at 1, 3 and 5 minutes. His mother was given phenobarbital until 1.5 months of pregnancy then carbamazepine 400 mg LP x 2/day, raised to 600 mg LP x 2/day at the 25th week of gestation because of epileptic crisis. The newborn was transferred at day 4 for drowsiness, mild jaundice, persistent vomiting and bouts of hypotonia/hypertonia, tremors and hyperexcitability. His plasma Tegretol level was 5.9 micrograms/mL and severe hypocalcemia (1.35 mmol/L) was noted. Hypocalcemia disappeared within 48 hours and gastric and neurologic troubles by day 6. The patient left the hospital at day 14. Case 2. Matheo, Esteban's brother, was born by caesarean section after 39 weeks of gestation, weighing 3,210 g. His Apgar score was 9, 10, 10 at first, third and fifth minutes. The mother's anti-epieptic treatment associated carbamazepine LP 400 mg x 3/day and vigabatrin four tablets of 500 mg/d until the 6th month of pregnancy and five tablets by day thereafter. The newborn presented vomiting from the first feeding; tremors were noted on day 2. His plasma Tegretol level was 5.7 micrograms/mL (N = 4-8 micrograms/mL) and the baby was transferred. Upon arrival, persistent vomiting and succession of hypotonia/hypertonia with intermittent opisthotonos were noted. Blood and urine tests showed: low calcemia (2.19 mmol/L), negative Brand reaction and DNPH test, normal urinary and blood amino acid chromatography. The course was spontaneously favourable and the child went home at day 11. CONCLUSION: Newborns of epileptic mothers treated with carbamazepine and/or vigabatrin during pregnancy should be placed under clinical observation during their first postnatal week. Calcemia monitoring is suggested for infants whose mothers were not supplemented with vitamin D during pregnancy. With a follow up of respectively 26 and 7 months, both brothers have normal milestones, confirming the transitory and benign character of reported side-effects.

[Histology and cytology of laparoscopically operated "simple ovarian cysts"]. / Histologie und Zytologie laparoskopisch operierter "simpler Ovarialzysten".

In a retrospective study the histopathological findings of 127 laparoscopically operated unilocular anechoic smooth-walled ovarian cysts have been correlated with clinical characteristics (age, duration of observation, complaints, hormonal treatment), size by ultrasound, kind and colour of cysts content as well as cytological findings. The age of patients differed from 16-61 years (mean +/- s: 36 +/- 16). The histopathologic findings yielded 15 (11.8%) functional cysts, 30 (23.6%) persistent corpus luteum cysts, 9 (7.1%) endometriomas, 7 (5.5%) cystic teratomas, 9 (7.1%) undifferenciated cysts and 57 (44.9%) cystadenomas. There were no differences between histopathologic diagnosis groups according to age and cysts size by ultrasound. Functional cysts with complaints (n = 6) may explain that the observation time in 60% of all functional cysts was smaller than 6 weeks, whereas persistent corpus luteum cysts, endometriomas, cystic teratoma and cystadenomas had been observed for longer than 6 weeks in more than two thirds. Intraoperative evaluation of cysts content as "chocolate"-like was suspicious of endometriomas, but was also present in cysts of other histopathological findings. By means of cytology, endometrioma (siderophages) was suspected in 44.4% and a cystadenoma in 42.1% of all histopathologically verified cases. In all, the cytologic findings were useful for correct histopathological diagnosis in only 33.9% of all 127 cases. It is concluded that differential diagnosis of simple ovarian cysts is not possible by clinical characteristics, neither by ultrasound nor by cytological evaluation. Ovarian cysts should be observed for at least two hormonal cycles. A hormonal treatment by combination preparations containing high doses of oestrogen is also recommended. In cases of persisting ovarian cysts laparoscopic removal is necessary.

[Aspiration cytology--endometrium diagnosis of peri- and postmenopausal bleeding disorders]. / Die Aspirationszytologie--Endometriumdiagnostik peri- und postmenopausaler Blutungsstörungen.

The aspiration of endometrial cell samples for cytological analysis in comparison to histological diagnosis with a following conventional curettage was evaluated in a symptomatic group of 100 women. The age ranged between 45 to 72 years. In 87% of the detected cytological and histological findings were comparable. In 2% the results were false negative. There was determined a specificity of 88.7% and a sensitivity of 88.2%. The usage as screening method in asymptomatic group of women may be a future interest of the endometrial cytology.

[Metastasis of bronchial carcinoma in the temporomandibular joint. Case report]. / Metastase eines Bronchialkarzinoms im Kiefergelenkbereich. Kasuistik.

Within 35 years 1008 patients were treated that were taken ill in a malignant tumor of face, jaw and mouth. There was found in five patients a distant metastasis of a carcinoma in lower yaw. One case with metastasis in left mandibular condyle is being described. The diagnosis was found by using conventional X-ray examination, Computertomography and aspiration cytology.

[Colposcopic, cyto- and histologic signs of papilloma virus infection in precancerous and early stages of cervix cancer]. / Kolposkopische, zyto- und histologische Zeichen einer Papillomvirusinfektion bei Vor- und Frühstadien des Zervixkarzinoms.

Basis of present study are examinations in 100 women with colposcopic and/or cytologic abnormalities suspect of preinvasive or early invasive carcinoma of the uterine cervix. We found 76 colposcopic abnormal findings in 100 women examined. In 36 women there was a colposcopic suspicion on a papilloma virus infection, in 32 cases combined with abnormal colposcopic findings. All 100 patients had cytologic smears group III and/or IV according to Papanicolaou. In 71 women cytologic signs of a papilloma virus infection was detected in the cervical smears. We found histologic signs of a papilloma virus infection in 69 cases in the specimen of biopsy, conization or hysterectomy (5 times condylomata acuminata, 53 times flat condylomata and 11 times inverted condylomata). Preinvasive respectively invasive and papillomavirus caused lesions of the cervix are coexisting in 59 cases. Our examination demonstrates that also in GDR in about 70 per cent of the precancerous or invasive cervical lesions signs of an infection with human papilloma viruses are present histologically and/or cytologically.

[Incidence, causes and follow-up of doubtful smear findings (Papanicolaou group III)]. / Häufigkeit, Ursachen und Verlauf zweifelhafter Abstrichbefunde (Gruppe Papanicolaou III).

Suspect smears of 622 patients from 1977-1986 were analysed for their causes and followed up until the definite cytologic or histologic result. In relation to the overall material of 97,963 cases the rate of suspect smears (group Pap. III) was between 1.18 and 0.27%, i.e. an average of 0.68%. The most frequent reasons for the classification "suspect" were inflammatory (42.4%), metaplastic or degenerative changes (16.1%) and doubtful pre-cancer (30.6%). 58% of all cases became negative under cytological control and antimicrobial therapy or hormonal substitution; of these 91.4% converted into negative within 6 months. The histological examination carried out on 230 patients revealed pre-cancer (CIN I-III) in 201 cases; cancer was proved in 5 cases. Compared to the whole population that is a rate of 33.1%. 24 cases were to be found negative. 139 Multiparae (67.6%) were to be found in the group of the 206 histological positive cases. 151 women (74%) had taken hormonal contraceptives. The rate of suspect smears should not exceed one per cent.

[Comparative cytophotometric and cytomorphometric studies of concave cells and atypical squamous epithelial cells of the cervix uteri]. / Vergleichende zytophotometrische und zytomorphometrische Untersuchungen an Koilozyten und atypischen Plattenepithelzellen der Cervix uteri.

Cytologic slides from 11 women with clinical, cytological and histological signs of a papillomavirus infection of the cervix uteri are investigated by cytophotometry and cytomorphometry. The mean values of DNA content, chromatin density, nuclear area and nuclear circumference of koilocytes were notably higher than for atypical or normal squamous cells. In those patients with concurrent cervical intraepithelial neoplasia the DNA content of koilocytes was inversely related to the degree of atypia. Squamous cells with HPV-induced lesions can be characterized by cytophotometry and cytomorphometry as a distinct cell population forming a continuum with the preneoplastic epithelium.

[Papilloma virus-induced changes in the uterine cervix. Histo- and cytologic and epidemiologic findings]. / Papillomvirusbedingte Veränderungen der Cervix uteri. Histo- und zytologische sowie epidemiologische Befunde.

In this epidemiological, cytological and histological study signs of papillomavirus infections were found in 128 cases (16,6 per cent) and dysplasia or carcinoma in situ in 713 cases in a series of 773 cone biopsies. Epithelial changes caused by papillomavirus were combined with preneoplastic lesions in 116 cases. Pretherapeutic cytologic examinations of the condylomatous epithelial changes secured histologically later on referred to cervical papillomavirus infections in 64 per cent. Epidemiological inquiries of patients with cervical papillomavirus infection correspond extensively to those with invasive carcinoma of the cervix and premalignant cervical lesions.

[Cytological finding in the pre- and early stages of cervix carcinoma--a contribution to the evaluation of Papanicolau III]. / Der zytologische Befund bei Vor- und Frühstadien des Zervixkarzinoms--ein Beitrag zur Wertung des Papanicolaou III.

Cytologic findings and the histologic diagnosis are compared in 326 cervical cones. We have found following ratio of the groups Papanicolaou (Pap) III: Pap IV--in dysplasia 1: 1: 1, in "more dysplasia than carcinoma in situ (CIS)" 1:2:2. The Pap IV dominates in "pure" CIS and in cones with "more CIS than dysplasia". We take out of the Pap III ("with cytologic control") cases named "Pap III with necessity for histologic diagnosis". We have found in this subgroup of Pap III prestages or early stages of cervical carcinoma.

[Results of a computer assisted screening program for gynecologic mass examinations (author's transl)]. / Ergebnisse eines computergestützten Screening-Programms für gynäkologische Grossfelduntersuchungen.

Four years experiences with a computer-assisted program for early detection of prestages and early cervical cancer in the district Rostock are reported. 96 265 women were examined. Pathological papsmears were found in 0.72%. The importance of a differential diagnosis of Papanicolaous group III is underlined.

[Comparison between histologic diagnosis and cytologic finding of pre- and early stages of cervical cancer (author's transl)]. / Vergleich zwischen histologischer Diagnose und zytologischem Befund bei Vor- und Frühstadien des Zervixkarzinoms.

Cytologic findings and the histologic diagnosis are compared in 326 cervical cones. Out of the Pap III ("with cytologic control") group, cases named "Pap III with necessity for histologic diagnosis" were evaluated separately. In this subgroup of Pap III, we have found prestages or early stages of cervical cancer.

[2-year analysis of the results of a screening program on computer basis for the detection of pre- and early stages of cervix carcinoma (model Rostock) (II)]. / 2-Jahres-Analyse der Ergebnisse eines Screening-Programms auf Computerbasis zur Erfassung der Vor- und Frühstadien des Zervixkarzinoms (Modell Rostock) (II)

Two years experiences with a computer-assisted program for early detection of prestages and early cervical cancer in Rostock-city are reported. 65% = 27028 women finally cooperated. Pathological papsmears were found in 0,52%. 9 cases of severe dysplasia, 30 carcinomata in situ, 3 cases of early invasion, 3 micro- and 5 macrocarcinomas were observed. Accessory findings were seen in 10,2%.

[Organization of mass-screening for early detection of cervical cancer and its precancerous conditions. II. report: Practical experience with a computer assisted mass-screening program (Model Rostock) (author's transl)]. / Organisation von Mass-Screening-Untersuchungen zur Erfassung der Vor- und Frühstadien des Zervix-karzinoms. II. Praktische Erfahrungen mit einem computergestützten Screening-Programm (Modell Rostock)

Two years experiences with a computerassisted program for early detection of prestages and early cervical cancer in Rostock-city are reported. From 43.000 women invited to take part in the examination, 27.028 = 65% finally cooperated. Pathological Pap-smears were found in 134 cases (= 0,52%). Histological examination in 51 cases (= 0,2%) showed 1 Erosio vera (false positive), 9 severe dysplasia, 30 carcinomata in situ, 3 early invasions (microinvasive cancer), 3 microcarcinoma and 5 macrocarcinoma. Accessory findings were seen in 10,2%. A good organized mass-screening-system with unique nomenclature, diagnostic and treatment of cervical cancer and its prestages gives the best supposition to cut down its rate of incidence.