[Therapy and prognosis of small breast cancers. Comparison of subcutaneous mastectomy procedures with ablatio mammae]. / Therapie und Prognose des kleinen Mammakarzinomas. Vergleich von subkutanen Mastektomieverfahren und Ablatio mammae.

A retrospective clinical study included 1283 patients with breast cancer. 307 of 762 tumours with known diameter (mm) were classified as stage pT1 (TNM, 70). Four groups were formed to compare the prognosis in subgroups of pT1 cancers: 0-5 mm (n = 22), 6-9 mm (n = 22), 10 mm (n = 53) and 11-20 mm (n = 210). A comparison of three types of surgery was made: Radical subcutaneous mastectomy (12), bilateral modified subcutaneous mastectomy (10, 11), and modified radical mastectomy (Auchincloss, 3). Both forms of subcutaneous mastectomy were combined with adjuvant postoperative radiotherapy to the side of the tumour. In this trial, patients were younger at diagnosis than usually stated in the literature. Small breast cancers had the same localisation and histology as large ones. Axillary lymph node metastases were identified from a tumour diameter of 6 mm upwards. Bilateral tumours were seen in 2 of 22 patients with tumours less than or equal to 5 mm. Multifocal growth was observed also in the same size range. Histologically different simultaneous invasive unilateral cancers were seen starting at a diameter of 8 mm of the larger tumour. Systemic metastases were observed in tumours of 10 mm in diameter. Local recurrences occurred in breast cancers with a diameter of 2 mm and more. There were no recurrences in the area of the nipple or areola in pT1 cancers. Small breast cancers did not appear to be biologically different from larger lesions. No prognostic subgroups of pT1 were evident beyond the established TNM staging. Disease-free survival was not significantly different between the three surgical approaches. Local recurrence was significantly less frequent after breast-conserving surgery. A negative influence of local recurrence on the prognosis was observed to a similar extent irrespective of the type of surgery. The concept of "minimal breast cancer" suggesting ablative surgery for a heterogeneous group of preinvasive and small invasive lesions is outdated. The different forms of subcutaneous mastectomy are a therapeutic alternative in the context of breast-conserving surgery of small infiltrating breast cancers. Especially the modified subcutaneous mastectomy (Beller) combines a good cosmetic result without prognostic impairment and with a potential reduction of the risc of contralateral breast cancer. Further potential applications include prophylactic treatment of high-risk patients with preinvasive lesions.

Plasma and intracellular Mg2+ concentrations in pre-eclampsia.

Plasma and intra-erythrocytic magnesium concentrations were determined in 27 patients with pre-eclampsia and in 22 healthy pregnant women. In the pre-eclamptic women, the Mg2+ concentrations were measured before and after treatment with Mg2+ salts and after delivery. The plasma Mg2+ concentration was not significantly different in the pre-eclamptic and the healthy pregnant women. The intra-erythrocytic Mg2+ concentration before treatment with Mg2+ was significantly lower in the pre-eclamptic patients than in the healthy pregnant women [1.33 +/- 0.29 versus 1.01 +/- 0.16 mmol/l (means +/- s.d.); P less than 0.05] and increased after treatment with Mg2+ to 1.19 +/- 0.24 mmol/l. Lowered cellular Mg2+ concentrations in pre-eclampsia may contribute to the development of hypertension in this disorder.

Validity of cytogenetic analyses from trophoblast tissue throughout gestation.

Cytogenetic findings in the Münster Chorionic Villi Sampling (CVS) program are presented after 1,184 first trimester transcervical samplings and 131 second and third trimester placentacenteses. In the first trimester series the abnormality rate is low (2.4%) in patients with only an age-dependent aneuploidy risk. In this group terminations were performed in only 1.6% because of aneuploidy. True mosaicism was found more frequently after CVS, and the risk of maternal cell contamination seems higher as compared to amniocentesis. There are no obvious differences in the overall rate of diagnostic errors after both procedures, when metaphases after direct preparation and chorionic cell cultures are analysed and doubtful findings such as mosaicism are adequately followed up by amniocentesis. The cytogenetic techniques also offer a very rapid approach to karyotyping in the second and third trimester. We found a high rate of aneuploidy (15%) when placentacentesis was performed after sonographic diagnosis of fetal abnormalities. We conclude that cytogenetic analysis from trophoblast tissue is an accurate diagnostic tool applicable from first to third trimester of pregnancy.

Bilateral breast cancer: the frequency of undiagnosed cancers.

The risk of developing cancer in the contralateral breast is five to seven times the risk of cancer occurrence for the normal female population. In patients in 365 consecutive operations, 15 frankly invasive cancers and four metastatic lesions were found in the contralateral breast as well as an additional 28 lesions in situ, totaling 13%. An additional 30% of the patients had severe dysplasia with an unknown potential for becoming cancerous. Only less than one third of the cancers in the contralateral breast were symptomatic (by palpation or mammography or both) but not recognized at the time of primary treatment. The majority of lesions in the contralateral breast are due to a second primary growth, and only a minority is metastatic. The results of 203 bilateral operations consisting of a modified subcutaneous mastectomy with axillary lymph node dissection and radiation are presented; this cosmetically acceptable procedure reduces the number of cancers in the contralateral breast to an incidence of 1% to 2%.

[Effects of various anesthesia procedures used in forceps delivery on the cardiopulmonary adaptation of the newborn infant. 1. Modification of cardiac adaptation]. / Die Auswirkungen verschiedener zur Forcepsentbindung angewandter mütterlicher Anästhesieverfahren auf die kardiopulmonale Adaptation des Neugeborenen. 1. Mitteilung: Die Beeinflussung der kardialen Adaptation.

Healthy, spontaneously born infants, delivered at the calculated time shows a postnatal tachycardia combined with harrowing of oscillation. But then there is a normalisation in heart action. This phenomenon is nearly the same both in spontaneous delivery and intubation anesthesia for forceps delivery starting with propanidid. Therefore propanidid is of less risk for the neonate. But after hexobarbital anesthesia our results reveal a lingering cardial adaption of the neonate, which is statistical significant. This points to possible cardiac depressive side effects of this drug. Therefore the usage of hexobarbital anesthesia should be well considered in obstetrics.

[Effects of various anesthesia procedures used in forceps delivery on the cardiopulmonary adaptation of the newborn infant. 2. Modification of pulmonary adaptation]. / Die Auswirkungen verschiedener zur Forcepsentbindung angewandter mütterlicher Anästhesieverfahren auf die kardiopulmonale Adaptation des Neugeborenen. 2. Mitteilung: Die Beeinflussung der pulmonalen Adaptation.

Mature newborns reveal the same pulmonal adaption to extrauterine conditions after forceps delivery in general anesthesia for the mother beginning with propanidid or hexobarbital as newborns after spontaneous delivery. Intervalls of apnoe, being physiological during neonatal adaption up to the fourth life-hour, occurred in all three tested groups in the same frequency. Genuine apnoe in combination with following bradycardia and cyanosis couldn't be observed. Moreover during the whole examination time all mean values of respiration frequency were physiological. Therefore we believe that there is no fundamental deterioration of newborns respiration, i.e. a depression in nerve-centre, caused by propanidid or by hexobarbital, despite of repeatedly contrary description.

[Effect of the oral beta-mimetic drug clenbuterol (Contraspasmin, Spiropent) and orally and intravenously administered Partusisten on the rheobase]. / Der Einfluss des oralen Betamimetikum Clenbuterol (Contraspasmin, Spiropent) sowie oral und intravenös verabfolgten Partusistens auf die Rheobase.

Clenbuterol (Contraspasmin, Spiropent) was used to treat threatened delivery in a dosage of three times 0.02 mg per day because of its beta-mimetic effects and the halflife time for elimination of 34 hours. We examined the effect of Clenbuterol on the maternal rheobase as a factor to estimate the influence of this drug on neuromuscular structures of maternal organism. After the first oral application of Clenbuterol we found a significant decrease in this value and after second and third application a distinct fluctuation. This fact shows besides the positive beta-mimetic properties the side-effects on the vegetative nerve system and on neuromuscular structures of the female body.

[Thrombophilic states in late gestosis]. / Thrombophile Zustände bei Spätgestose.

In 80 pregnant women with pre-eclampsia and in 38 healthy pregnant women malondialdehyde production by blood platelets, platelet survival and several haemostatic variables were determined. It was demonstrated that due to the enhanced platelet turnover pre-eclampsia was invariably accompanied by a thrombophilic state which in severe cases developed into chronic consumption coagulopathy.

[Clinical and therapeutic aspects of pelvic vein thrombosis in pregnancy and puerperium]. / Klinische und therapeutische Aspekte der Beckenvenenthrombose in der Schwangerschaft und im Wochenbett.

Deep pelvic thrombophlebitis means a severe complication of pregnancy and puerperium and requires an adequate well-timed treatment. Over a period of 10 years 32 pregnant women with thrombosis of deep pelvic veins have been attended. Treatment of choice is the application of heparin in adequate high dosage. Therapy by streptokinase is indicated in individual case only. 90 per cent of our cases treated in this way have successfully been cured.

[Obstetrical neuroleptanalgesia as a procedure for pain control in the peripartal period of the problem patient]. / Die geburtshilfliche Neuroleptanalgesie als Verfahren zur Schmerzbekämpfung in der peripartalen Periode der Problempatientin.

Report on 35 patients treated by obstetric neuroleptanalgesia in the course of labour. This method doesn't appear to be qualified for general application. Nevertheless this kind of analgesia offers an additional possibility to influence the progress of labour favourably.

[Use of beta mimetics in cerclage operations]. / Zur Anwendung von Betamimetika im Rahmen der Zervixverschlussoperationen.

This paper deals with the change of rheobase in connection with the cerclage of cervix uteri. For this reason special attention is paid to the starting value of rheobase before operation and its reaction after cerclage using comparable parameters like pelvic score, gestational age at the beginning of lying-in treatment and date of cerclage. Based on our results we have to state that a cerclage is justified only in genuine insufficiency of cervix uteri provided there are no contractions, and the rheobase at the starting point is above of a defined level.

[Diaplacental influence on the disseminated intravascular coagulation (DIC) in an asphyxia model. I. Influence on the vasal tonus and on the vasal wall (author's transl)]. / Diaplazentare Einwirkung auf die disseminierte intravasale Gerinnung (DIC) im Asphyxiemodell I. Gefässtonus- und Gefässwandbeeinflussung.

With the aid of an asphyxia model in rabbit fetuses the possibility of diaplacental influence on the hypoxic effects of the fetal organism has been investigated. The trial to change the vasotonia during the asphyctic shock by sympathicomimetic or -lytic drugs (Dilatol, Obsidan, Ergocomb, Regitin) remained to be without any effect on the DIC in the fetal organism. Trying to seal the vascular wall by the high-molecular-weight basic polypeptide Aprotinin there seemed rather to be an increase of the intravascular fibrin sedimentation.

[Diaplacental influence on the disseminated intravascular coagulation (DIC) in an asphyxia model. II. Influence on the vessel's content (author's transl)]. / Diaplazentare Einwirkung auf die disseminierte intravasale Gerinnung (DIC) im Asphyxiemodell II. Beeinflussung des Gefässinhaltes.

There is reported on the possibilities of diaplacental influencing on the DIC arising from the hypoxia we provoked with the help of an asphyxia model in rabbit fetuses. We could demonstrate the impossibility of influencing on the fetal vasal content by means of low molecular dextran, heparin or streptokinase. On the contrary, the possibility exists to influence on the fetal hemostasis by low molecular synthetic substances. The antifibrinolytic drug PAMBA causes in case of advanced acidosis diaplacental a definite growth of the intravascular coagulation, as well. But an inhibition of the fibrin sedimentation in the terminal vessels at the asphyctic shock can be achieved by applying the ethyl ester of the 4-amidinophenylpyruvic acid (APPA).

[Results of eclampsia treatment--analysis of 44 cases over 20 years (author's transl)]. / Ergebnise der Eklampsiebehandlung--Analyse von 44 Fällen aus 20 Jahren.

Reported in this paper are 44 cases of eclampsia recorded from among 61,809 deliveries at the Gynaecological and Obstetric Hospital of the Medical Academy of Erfurt, between 1960 and 1979. Five mothers died and two more suffered permanent damage. Two infants died perinatally. However, an estimate of eclampsia risk to patients with gestosis cannot be derived from the intensity of the gestosis symptoms and thus from the gestosis index (Goecke).

[Deliveries by caesarean section--variation of indications (author's transl)]. / Ergebnisse der Geburtsbeendigung durch Kaiserschnitt aus dem Blickwinkel der veränderten Indikationsstellung.

Reported are 657 cases of caesarean section performed in selected periods over the past two decades. An account is given of change in indications and the results accordingly achieved. Particular reference is made to higher risk of infection due to antepartum and intrapartum intensive care. Indications should continue to be based on most stringent criteria.