Contamination of human milk in Middle Hesse, Germany--a cross-sectional study on the changing levels of chlorinated pesticides, PCB congeners and recent levels of nitro musks.

Human milk samples from women in Middle Hesse, Germany were chemically analyzed for contamination levels of alpha-, beta- and gamma-HCH, HCB, p,p'-DDE and p,p'-DDT as well as the PCB-congeners no. 28, 31, 49, 52, 101, 118, 138, 153, 156, 170 and 180. Changes in concentrations of these compounds in human milk over an extended time period were studied by comparing samples from 1984/85, 1990/91 and 1995. In addition, concentrations of the nitro-aromatic compounds musk xylene and musk ketone were determined in the 1995 samples. The study showed statistically highly significant (p<0.001) reductions in levels of beta- and gamma-HCH, HCB, p,p'-DDE and p,p'-DDT, in human milk from 1995 compared to samples from 1984/85. A weakly significant reduction (p<0.05) of alpha-HCH was also observed. For low-chlorinated PCB congeners, on the other hand, a highly significant increase of PCB no. 28 was detected and concentrations of congeners no. 31, 49 and 52 remained unchanged. Concentrations of the high-chlorinated congeners no. 101, 138, 153 and 180 dropped (highly significant). A highly significant reduction of PCB no. 118 and 156 occurred between 1990/91 and 1995, but a highly significant increase was found for no. 170. Lower levels of hydrocarbon contamination of human milk samples from 1995 than were found in samples from 1984/85 and 1990/91 can be seen to result partially from voluntary reductions, but primarily reflect restrictive environmental legislation in the Federal Republic of Germany. Mean concentrations of musk xylene and musk ketone in samples from 1995 were 41 microg/kg and 10 microg/kg milk fat, respectively.

[Therapy of primary fallopian tube cancer--a retrospective study of 30 cases]. / Therapie des primären Tubenkarzinoms--eine retrospektive Studie über 30 Fälle.

Between the years 1968-1988 30 patients with primary carcinoma of the fallopian tube were treated in the Department of Obstetrics and Gynecology of the University of Kiel. In 27 cases the initial treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. In 3 cases where the patients had undergone surgical treatment in another hospital a second operation for completion was performed. 2 patients received no further treatment after surgery. Postoperative radiotherapy was given to 20 patients and a combined treatment with radiation and polychemotherapy was implemented in 5 cases. Postoperative treatment in 3 patients was poly-chemotherapy alone. The 5-year-survival rate taking all tumor stages and modes of therapy employed into consideration was 36.7%. In analysing the survival rate for small numbers as directly related to postoperative treatment a 5-year-survival rate for radiotherapy of 35% (7/20) and for radiation therapy plus poly-chemotherapy of 40% (2/5) was found. After operative treatment followed by poly-chemotherapy alone one of three patients survived after 5 years.

[Results of different forms of therapy in vulvar neoplasms]. / Ergebnisse unterschiedlicher Therapieformen bei Vulva-Neoplasien.

In this retrospective study 216 patients who have been treated for malignant vulva neoplasms between the years 1968 and 1987 at the Department of Obstetrics and Gynaecology of the University of Kiel are reviewed. Staging according to the Figo-Classification revealed stage I in 13.0%, stage II in 63.0%, stage III in 20.2% and stage IV in 3.8%. During these years treatments applied to these elderly patients often with multimorbidity, aside from the combined treatment according to Berven (27.9%) was in the majority of cases a modified radical treatment (34.1%). The modified radical treatment consisted primarily of simple vulvectomy and tumor excision followed by radiation therapy. Primary radiation therapy was performed in the cases where either local or general noperabilityx was established (29.3%). The 5-years-survival rate of the investigated patients was 31.7%, whereby radical vulvectomy which was performed in a few cases offered the best results. A comparison between the modified radical therapy and the combined therapy according to Berven resulted in equally divided staging groups similar 5-years-survival rates of 39% and 38% respectively. However, the modified radical therapy group demonstrated better results in the first 4 years. Within the modified radical treatment group patients undergoing simple vulvectomy revealed a better survival rate after 3 years than did patients undergoing tumor excision followed by radiation therapy. The long term results of these two modes of modified treatment equal out over 10 years. Therefore, from the results presented we recommend in the case of elderly patients with multimorbidity the modified radical therapy via simple vulvectomy.

Pelvic abscesses: pelviscopy or laparotomy.

Between 1983 and 1988, we treated 66 patients with pelvic abscesses. Twenty-five patients required laparotomy and 41 underwent pelviscopy for treatment. The choice of the operative procedure, laparotomy or pelviscopy, depended on the age of the patient, the clinical presentation and the operative findings. The two collectives demonstrated no differences in the duration of hospitalization and in-patient treatment with antibiotics. A conservative, organ-preserving procedure could be performed in 80% of patients operated pelviscopically. In follow-up examinations 1-2 years after operation, 27% of the patients treated per pelviscopy complained of chronic abdominal pain as compared to 37% of those treated per laparotomy. In young patients, pelviscopic treatment of pelvic abscesses is a valuable alternative to laparotomy.

PIP: Physicians at Christian Albrecht University Hospital in Keil, West Germany treated 66 women with pelvic abscesses between 1983-1986. Pelviscopically treated patients were younger than laparotomy treated patients and IUD usage occurred 17% vs. 20% respectively. They 1st treated many patients with ampicillin and metronidazole or ampicillin and clavulanic acid. They were able to perform pelviscopy on 25 of the 33 patients with inflamed Fallopian tubes. 9 of these women experienced either a uni- or bilateral salpingectomy or salpingo-oophorectomy. They were able to do an organ preserving procedure designed to preserve fertility in 80% of the women, especially pelviscopically treated patients (81% vs. 16% laparotomy patients). They performed a laparotomy on the 6 patients with bilateral total abdominal tuboovarian abscesses. Of the 25 women who underwent a laparotomy, 20 required only a uni- or bilateral salpingectomy or salpingo-oophorectomy and 5 required a total hysterectomy and bilateral salpingectomy. No differences existed between pelviscopically and laparotomy patients in number of days in the hospital and duration of inpatient antibiotic therapy. Even though more laparotomy treated patients (37%) experienced chronic abdominal pain following treatment than pelviscopically treated patients (27%), the laparotomy patients initially experienced more severe and extensive infections than did pelviscopically treated patients. Of the 45 patients who were able to be examined 1-2 years after surgery, only 3 experienced recurrent pelvic inflammatory disease (8% of pelviscopically treated patients and 5% of laparotomy patients) which the physicians found encouraging since pregnancies may occur. In conclusion, to preserve fertility, they advocated pelviscopy along with organ preservation for patients in their reproductive years.

Chromogalactography preceding ductal-lobular unit excision for nipple discharge--with special reference to diagnostic galactography and histology.

Between 1981-88, 223 surgical interventions were performed in cases of pathologic breast secretion after exclusion of extra-mammary aetiology. The milk duct was identified by pre-operative chromogalactography, followed by a selective excision of the ductal-lobular unit. In 36 cases (16.1%), however, neither spontaneous nor provocable secretion remained after diagnostic galactography, so that a segment resection was required. In all tissue specimens, the cause of the pathologic secretion was found histologically; most often, it was fibrocystic disease or solitary intraductal papilloma (21.5% each). In 32.3% of the specimens, findings with a prospective significance (papillomatosis, carcinoma in situ or invasive carcinoma) were discovered and further operative treatment was initiated. The colour of the discharge allowed no prediction of the histological findings. In 28.6% (8/28) of the carcinomas, secretion was bilateral. In 46.4% of the specimens containing carcinoma, papillomatosis was also detected; vice versa, papillomatosis was associated with carcinoma in 22.8%. The recurrence rate of 1.6% indicates the efficiency of this method in removing the pathology. The diagnostic value of galactography for the prediction of findings with a prospective significance was considerably reduced by a rate of 37.5% false-negatives; therefore, we have decided to omit diagnostic galactography in our patients. Now, provided extra-mammary causes of the nipple discharge have been excluded and mammography has been inconspicuous, a selective excision of the ductal-lobular unit is performed after preoperative chromogalactography.

Nonpalpable breast tumors: diagnosis with stereotaxic localization and fine-needle aspiration.

Modern mammography is the most effective means of detecting nonpalpable breast cancers, but correct diagnosis for malignancy is made in only 20%-30% of the cases. The conventional method of lesion localization usually results in approximate placement of the hookwire in the breast. The authors report the results of stereotaxic localization, combined with fine-needle aspiration and cytologic study, performed in 528 cases. Clinically occult breast lesions were localized precisely (within 2 mm 96% of the time), sampled by means of a 23-gauge needle, and marked with either methylene blue or a hookwire for subsequent open excisional biopsy. The results indicate a sensitivity of 95%, specificity of 91%, and accuracy of 92% for the fine-needle aspiration procedure. This technique offers a significantly improved preoperative method of diagnosing small breast lesions with minimal pain, no complications, reduced cost, and no disfigurement or scar interfering with subsequent mammographic follow-up.

Incidence of adhesions in the true pelvis after pelviscopic operative treatment of tubal pregnancy.

33 patients with tubal pregnancies, who had been treated by pelviscopy with organ preservation between 1978 until the beginning of 1988 have had follow-up examinations from within 4 months to 2 years after their first operation. In 15 (45%) of these 33 patients we found adhesions in the true pelvis on initial pelviscopy; these adhesions were lysed in all cases. During a second inspection of the abdominal cavity-either by laparotomy (Cesarean section; 4 patients) or by repelviscopy (29 patients)-mainly avascular, filmy adhesions on one or both adnexae were found in 17 cases (52%). The pelviscopic treatment of ectopic pregnancy does not completely prevent the development of postoperative adhesions. The concomitant pelviscopic adhesiolysis during the treatment of ectopic pregnancy reduces the degree of severity of the recurring adhesions.

[Biological significance of estrogen receptor status in axillary lymph node metastases of invasive ductal breast cancers]. / Biologische Bedeutung des Ostrogenrezeptorstatus in axillären Lymphknotenmetastasen invasiver duktaler Mammacarcinome.

One hundred and fourty-nine axillary lymph node metastases of 35 female patients with invasive breast carcinomas were investigated immunohistochemically for their estrogen receptor (ER)-status. In addition, proliferative activity of the metastatic deposits was determined with the monoclonal antibody Ki-67. Twenty-four primary tumours were ER+ and 11 ER-. Lymph node metastases were ER+ in 21 of the 24 cases where the primary tumour was ER+. In 10 of the 11 cases with ER- primary tumours, the metastases were also ER-. In any given case, the lymph node metastases proved to be either all ER+ or all ER-. Negative ER-status was found to be related to higher numbers of axillary node metastases and higher maximum proliferative activity of the metastatic tumours. Follow-up at 2 years after diagnosis revealed a significantly lower incidence of distant metastases in patients with ER+ primary tumours.

Stereotaxic needle localization and cytological diagnosis of occult breast lesions.

A stereotaxic technique for localization of occult breast lesions and fine needle aspiration for cytological diagnosis was used on examination of 543 patients. Successful localization with the needle tip within 1 mm of the suspected lesion was possible in 490 patients (90.2%). Based on a high mammographic index of suspicion for malignancy, 187 of 490 patients were selected to undergo open biopsy, following aspiration cytology and localization with methylene blue injection. The statistical results (cytologic vs. histologic examination) revealed a sensitivity of 97.5% and a specificity of 95.2% for cytologic diagnosis of occult breast lesions. The technique is easy to learn and takes 20-30 minutes to perform. Compliance was 100% and complications were nil. This new technique expedites localization and maximizes the specificity of mammography for occult breast lesions.

[Radio-in-vitro studies of the thyroid status of mature newborn infants immediately post partum]. / Radio-in-vitro-Untersuchungen zur Schilddrüsensituation des reifen Neugeborenen direkt post partum.

145 cord sera from fullterm, vital eutrophic newborn babies of uncomplicated pregnancies have been tested for the thyroid gland parameters RT3-U, ST3-U, T4, T3, T4/T3-ratio, total balance of free iodine-hormone indices and TSH to answer the questions of the thyroid gland situation. In the fullterm newborn baby an euthyroid metabolic balance was found on comparison with the simultaneously determined thyroid specific situation of the adult. The T3-situation is identical with that of the euthyroid adult. Thyroid levels, the conversion of T4 to T3 as well as the values of the total balance are slightly elevated, like in women under contraceptive hormone therapy. The basal TSH secretion immediately post partum is similar to the one on day 5 post partum.