[Champagne administered by spoon for peritonitis after cesarean section. From the history of obstetrics in Erlangen--data from about 60,000 deliveries in 100 years]. / Bei Peritonitis nach Sektio Champagner löffelweise. Aus der Geschichte der Geburtshilfe in Erlangen--Daten von rund 60,000 Entbindungen in 100 Jahren.

The University of Erlangen has been engaged in clinical obstetrics for approximately 170 years. During this time, Erlangen University's delivery house, opened in 1828 and at first having considerably less than 50 births a year, developed into a perinatal centre with approximately 1,700 births a year. For the period from 1880 to 1981, a group of MD students reviewed the existing records and evaluated 60,000 births with respect to more than 40 parameters. Part of the results obtained are shown with special reference to operative obstetrics. Apart from the general influence of the scientific development on decisions and results within obstetrics, individual factors were also recognizable, factors which are linked with the experiences, insights and specialized working areas of the particular head of the hospital.

[Long-term study of the significance of hormone receptors as prognostic factors in breast cancer]. / Langzeituntersuchung zur Bedeutung von Hormonrezeptoren als Prognosefaktoren beim Mammakarzinom.

To check the question as to the prognostic significance of oestrogen and progesterone receptors in invasive breast cancer, the course of the disease was registered in 660 patients in the context of a retrospective study. These patients had been operated on with the objective of curing breast cancer between 1976 and 1984. A receptor analysis of these patients is available with regard to both receptor types. Positive progesterone receptors could be detected in 38%, positive oestrogen receptors in 70%. Values over 15 fmol/mg tissue protein were rated as positive. The proportion of oestrogen-receptor-positive tumours increased with the age of the patients. On the other hand, the progesterone receptor did not show this dependence. During analysis of the median receptor concentrations as well as of the progesterone combinations, a correlation between the axillary lymph node status and the hormone receptor status of the primary tumour could not be observed for the two receptor types. The survival time in relation to the oestrogen receptor status did not indicate any significant effect on survival time. On the other hand, the improvement of survival time depending on the positive progesterone receptor status was highly significant in statistical terms (p less than 0.001) especially in nodal-positive patients. Both patients with axillary lymph node metastases and positive progesterone status, compared with patients without lymph node invasion and a negative progesterone status, had the same survival rate.

Incidence of double minutes, cytogenetic equivalents of gene amplification, in human carcinoma cells.

Screening of the occurrence of double minutes (DM) was performed in more than 1,000 metaphases obtained from a total of 22 solid human breast tumours and more than 3,600 metaphases from a total of 55 malignant effusions (45 patients with different types of carcinomas). DM were observed in 15 of these breast tumor cases and in 34 of the effusions (obtained from 29 cancer patients). The percentage of cells exhibiting DM as well as the number of DM per respective cell varied widely. It could be seen that metastatic cells from malignant effusions exhibited on the average more DM per cell than did cells of primary breast carcinomas. Differences in the incidence of DM could be observed between different carcinomas as well as between different age groups. In addition, it did not appear that DM could be induced by mutagenic tumor therapy. DM are thus not a rare finding in human solid tumors but, as cytogenetic equivalents of gene amplification, they rather represent a fundamental biological characteristic of tumor development.

Chemotherapy for advanced recurrent carcinoma of the cervix. A report on the treatment of 22 patients.

In 22 patients with advanced squamous-cell carcinoma of the cervix, chemotherapy with adriamycin and methotrexate was attempted. Remission occurred in five patients, being complete in two of these. The median duration of remission was 8 months. In eight patients, the course of the disease was stabilized for at least 3 months. The median survival time was 3 months for the group of "failures', 11.5 months for those with stable disease, and 21 months for patients in remission. The most favourable course of the disease was observed in the two patients with complete remission; they survived for 31 and 32 months, respectively, after the start of chemotherapy.

Correlations of the receptor content and ultrastructure of breast cancer cells.

Receptor assay results were compared with the ultrastructure of 127 breast cancers (112 primary tumors, six recurrent lesions, nine metastases). Tumors were considered to be receptor positive if the receptor levels were greater than or equal to 15 fmol/mg of soluble tissue protein. Most breast cancer had heterogenous cells with different grades of ultrastructural differentiation. a prevalence of well-differentiated cancer cells and an abundance of intracytoplasmic vacuoles had a significant correlation with a positive estrogen receptor status. The correlation was better than between malignancy grades and receptor content. The type of breast cancer and the menopausal status bore no relation to receptor content. Progesterone receptors were found in well-differentiated tumors of low malignancy.

Prognostic significance of the steroid receptor content in primary breast cancer.

Recurrence and survival rates were studied in 222 patients with primary breast cancer with particular reference to relations with the estrogen and progesterone receptor content of the primary tumor, involvement of axillary lymph nodes and menopausal status. The median observation time for these 222 women was 46 months, the longest being 88 months and the shortest for recurrence-free survivors, being 42 months. Within the first 4 years after primary surgery, recurrences occurred more rarely and later in patients with receptor-positive cancers. After 70 and 50 months, respectively, there was no longer any difference between estrogen receptor- and progesterone receptor-positive and receptor-negative cases. The overall survival curve plotted in accordance with Kaplan and Meier [5] was more favourable for patients with estrogen receptor-positive carcinoma than for those with estrogen receptor-negative tumors, even after 6.5 years.

[The results of 5 years of ancillary chemotherapy of carcinoma of the breast (author's transl)]. / Fünf Jahre adjuvante Chemotherapie beim Mammakarzinom.

484 women were operated between July 1, 1975 and December 31, 1978 for carcinoma of the breast. At least 18 months of follow-up was available until July 1, 1980. 273 patients were observed. 151 women had ancillary chemotherapy with cyclophosphamide, methotrexate, vinblastinsulphate and fluoro-uracil for six cycles. In an additional 60 patients chemotherapy was interrupted for post-operative radiotherapy after three cycles. The premenopausal patients were most helped by ancillary chemotherapy. This was not explained by more frequent mistakes in the treatment of post-menopausal patients. The post-operative radiotherapy did not bring a discernible additional advantage to ancillary chemotherapy. The best results were obtained in women who had no regional metastases in the lymph nodes independent on the size of the primary tumour.

Steroid receptors and response to endocrine treatment and chemotherapy of advanced breast cancer.

The remission rates after endocrine and cytostatic treatment were determined in 192 female patients with advanced breast cancer depending on the estrogen, progesterone, and androgen receptor content and on the disease-dominant site. Of 60 women with tumors containing estradiol receptors 39 responded to endocrine treatment. This was only true in two of 31 women without estradiol receptors. Tumors which contained binding sites for both estradiol and progesterone had a higher remission rate after endocrine therapy than those with estradiol receptors only. Remission rates after polychemotherapy were also higher in tumors with binding sites for estradiol as well as for progesterone. The localisation of metastases seems to be of lesser importance for the remission rate than the receptor content. Liver metastases are an exception. Here, no remissions could be observed with endocrine treatment even if ER and PR were present. The median remission rate was 9 months for hormonally treated patients and 10 months for those undergoing chemotherapy. The median survival time after chemotherapy is 18 months higher for responders than for non-responders. This difference is 15 months with endocrine treatment. Two years after the start of endocrine treatment 60% of the responders but only 20% of the non-responders were still alive. Based on our results together with histomorphological studies and the evaluation of recurrence and survival it can be assumed that carcinomas, which by nature follow a more benign course, do contain estradiol receptors.

Changes in the glycosaminoglycans distribution pattern in the human uterine cervix during pregnancy and labor.

The glycosaminoglycans distribution pattern of uterine cervix samples obtained from 42 women of reproductive age was determined by means of proteolytic digestion and subsequent chromatographic separation. The following glycosaminoglycans were detected: chondroitin 4- and 6-sulfates, dermatan sulfate, hyaluronate, chondroitin, and keratan sulfate. The connective tissue of the uterine cervix shows a characteristic distribution pattern with regard to glycosaminoglycans which does not correspond to that found in any other tissue studied so far. Based on dry weight, the content of keratan sulfate increases during pregnancy while the concentration of chondroitin remains unchanged. The chondroitin sulfates and dermatan sulfate drop simultaneously. During labor chondroitin increases threefold. The hyaluronate content of the postpartum cervix is higher than that of the cervix in nonpregnant women. Both changes in the solubility of collagen as well as in the distribution pattern of the glycosaminoglycans seem to be related to cervical dilatation.

PIP: This study attempted to quantitate the presence of glycosaminoglycans in the uterine cervix during pregnancy and labor. Distribution patterns, within the cervical samples, of the glycosaminoglycans were determined by proteolytic digestion and subsequent chromatographic separation. Cervical samples studied were from 42 women of reproductive age. During pregnancy, the keratan sulfate content increased significantly; the chondroitin concentration remained unchanged; and the contents of the chondroitin sulfates and dermatan sulfate decreased. During labor, a considerable rise of chondroitin was noted, whereas the concentrations of keratan sulfate, chondroitin 4- and 6-sulfates, and dermatan sulfate did not change. Hyaluronate content of a postpartum cervix was significantly higher than in nonpregnant women. The total glycosaminoglycans content (related to dry weight of the cervix) was not larger during pregnancy as compared with samples of nonpregnant women. During labor, however, there was an increase from 8.57 mcmol/gm of dry weight. The hydroxyproline content dropped during pregnancy and labor. The ratio of total glucosaminoglycans content to that of hydroxyproline changed in favor of the glycosaminoglycans during pregnancy, and it became more pronounced during labor. Distribution patterns of serial transverse cervical sections showed an increasing content of hyaluronate from the external os upward to the lower uterine segment. The other glucosaminoglycans did not show any definite trend. Both the changes in the solubility of collagen as well as glycosaminoglycans distribution patterns were related to cervical dilatation.

[Relaxin and cervical dilatation during parturition (author's transl)]. / Muttermundseröffnung und Relaxin.

Relaxin concentrations during pregnancy and parturition were measured in tissue specimens of the uterine cervix of 27 women in childbearing age. During pregnancy relaxin levels increase from 0.4 guinea pig unit (GPU) to 0.94 GPU/mg soluble tissue protein. Already during parturition (0.41 GPU) and immediately post partum (0.39 GPU) the hormone concentrations have dropped back to normal. It appears that the biochemical changes which occur in the connective tissue of the uterine cervix during pregnancy and parturition are influenced by relaxin. Experimental animals were taken to show if relaxin acts by activation of collagenolytic enzymes. In the mouse a rise in the activity of collagen-peptidase and of the inhibitor of collagen-peptidase in plasma was found after subcutaneous injections of relaxin. The addition of human cervical tissue extracts resulted in an increase of enzyme-activation (even higher than could be expected of the hormone concentrations of the individual extracts). The highest levels of the enzyme were found after injections of extracts from cervical tissue specimens of parturient women.