[Innovative concepts for surgical treatment of the carcinoma of the breast]. / Innovative Konzepte zur operativen Behandlung des Mammakarzinoms.

Breast conserving therapy is a stable element in primary breast cancer treatment. Conservation and also restoration of the breast improve the outcome concerning psychological aspects. Surgical interventions include techniques for classical breast conservation as well as oncoplastic procedures like reduction mammaplasties and different types of flaps. Theses modern surgical procedures should be realised in a breast center.

Cytology of ascitic fluid in a patient with metastasizing malignant Brenner tumor of the ovary. A case report.

BACKGROUND: Transitional cell ("Brenner") tumors represent about 2% of all ovarian neoplasms. Brenner tumors are almost always benign. Malignant Brenner tumors of the ovary resemble urothelial carcinomas and are extremely rare. CASE: A 77-year-old, white female presented with malignant Brenner tumor in both ovaries as well as lung and abdominal metastases. The cytology of the ascitic fluid revealed many activated mesothelial cells and three-dimensional cell clusters arranged in a papillary pattern. The round to oval nuclei displayed mild anisokaryosis and hyperchromasia but had a quite evenly dispersed opaque or finely granular nucleoplasm. Enfoldings of the nuclear membrane gave them the appearance of so-called coffee bean nuclei. The cytoplasm stained light bluish. CONCLUSION: Knowledge of the cytologic features of ascitic fluid might allow a preoperative diagnosis of malignant, or at least proliferating, ovarian Brenner tumor.

Hydrosalpinx formation and its regeneration after microsurgical reconstruction--a functional and morphological study on rabbits.

The development of mechanically induced hydrosalpinx and the subsequent regeneration of the uterine tube following correction were investigated with reference to morphological and functional parameters in 33 rabbits. Mechanically induced hydrosalpinx leads to reduced fertility. The characteristic morphological alterations are flattening of the folds, deciliation, reduced secretory activity and general de-differentiation of the epithelial cells. The intensity of these changes peaked as little as 4 weeks after induction of the hydrosalpinx. The deciliation is generally patchy. The division into different fields, islet formation and celestial chart phenomena reflect different degrees of vascularization and/or oxygenation. These alterations were completely reversible within 8 weeks after reconstruction. In isolated cases only the formation of polypose stumps was seen, which were, however, covered with a normal epithelial surface. The discrepancy between the reduced tubal function following reconstruction for hydrosalpinx and the complete regeneration of the tubal mucosa suggests that other regulatory mechanisms more important for the function of the uterine tube are impaired.

[Healing of tubal anastomoses--microsurgery vs. fibrin gluing: morphologic aspects]. / Die Heilung von Tubenanastomosen--Mikrochirurgie vs. Fibrinklebung: morphologische Aspekte.

The healing of anastomoses either by microsurgical suture technique or by fibrin sealant technique has been examined in an experimental morphological study. With view to morphological criteria the healing of tubal anastomoses after one month is completed. Afterwards only little areas of regeneration could be found in the region of the anastomosis. These statements are valid for both types of anastomoses. In single cases a more progressive regeneration of the mucosa could be demonstrated. Using fibrin glue a more pronounced fibrosis could not be seen.

Fibrin glue for anastomosis of the fallopian tube--morphology.

In a morphological study fibrin-glued tubal anastomoses were compared with classical anastomoses using microsutures. In the isthmic-isthmic anastomoses, whether they were glued or sutured, the opposition of the folds and the continuity of the tubal wall were good. Scanning electron microscope studies of Fallopian tubes subjected to anastomosis using fibrin glue or microsurgical sutures showed a break in the fold structure regardless of the technique used, with formation of polyp-like and tuborous structures in some of the anastomoses in the ampullary region. In one case of an ampullar-ampullar anastomosis with fibrin glue, formation of a fistula was observed and in another case of the same type of anastomosis a hydrosalpinx developed as the consequence of intratubal adhesions and stenosis. In glued anastomoses in particular, intraluminal fibrin deposits were observed. Otherwise our scanning and transmission electron microscope investigations of the region of the anastomoses revealed a normal cell picture with abundant cilia-bearing, structurally unremarkable cells. Fibrin glueing can thus be regarded as a possible alternative to the conventional microsurgical suturing technique for the construction of anastomoses in the isthmic segment of the tube. In the case of wide-lumen ampullary anastomoses, however, the danger of fistula formation, dehiscence, development of intraluminal adhesions and stenosis must be regarded as increased. Fibrin glueing also does not appear to be appropriate for anastomoses requiring approximation of differing luminal widths.

[Endoscopically assisted construction of a neovagina--surgical technique and experience]. / Die endoskopisch assistierte Anlage einer Neovagina--Operative Technik und Erfahrungen.

The specific disadvantage of the Vecchietti technique for construction of a vagina in cases of vaginal agenesis is the need for laparotomy. We describe an endoscopically assisted construction of a vagina by a variation of this method and report on the first five cases operated on without any complications and with good functional results.

[Prevention of adhesions with dextrans]. / Adhäsionsprophylaxe mit Dextranen.

The effect of doses and molecular weight of dextrans on intraperitoneal adhesion formation were studied in an animal model. With increasing molecular weight the maximum effect is achieved with smaller quantities of the solutions. Because of the adhesion preventing properties, in cases of single and also multiple applications, dextran 60 should be preferred to other high molecular solutions.

Fibrin glue for reanastomosis of the fallopian tube in the rabbit: adhesions and fertility.

Fertility and adhesions were examined in 41 rabbits in three treatment groups following the construction of microsurgical anastomoses with fibrin glue and by conventional suturing techniques. The three types of treatment were: isthmic anastomoses without resection, ampullary anastomoses, isthmic anastomoses following resection of oviduct segments. There were no significant differences between the two methods of performing the anastomoses in any of the three groups with respect to number of ovulations, number of implantations, nidation index, and pregnancy rate. The extent of the formation of adhesions was also no different between the two types of anastomosis construction. From the functional point of view, fibrin glueing of the tubes can be considered as good as microsurgical suturing. Another study is planned to examine whether this is also true from the morphological viewpoint. It must be remarked that fibrin glueing does not appear to be suitable for anastomoses in which a lumen-adjusting technique is needed or for deep tubocornual or intramural anastomoses.

An endoscopically assisted technique for construction of a neovagina.

The specific disadvantage of the commonly used Vecchietti method for reconstruction of the vagina in cases of vaginal agenesis is the need for laparotomy. We now describe a successful endoscopically assisted construction of a neovagina by a variation of the Vecchietti method. The method causes relatively little stress to the patient.

[Functional aspects of healing in microsurgical tubal anastomosis--experimental studies of the rabbit fallopian tube]. / Funktionelle Aspekte der Heilung von mikrochirurgischen Tubenanastomosen--experimentelle Untersuchungen an der Kaninchentube.

Ovarian function and fertility was studied in 46 female New Zealand White rabbits after isthmic-isthmic reanastomosis of the oviduct. Postoperative ovarian function was slightly suppressed and returned to normal after two month. No significant differences were found between the control side and the side of anastomosis. Fertility was reduced directly after surgery on the side of anastomosis as well as on the control side. On the side of reanastomosis a continuous increase of tubal function occurred up to two month after surgery. At this time tubal function was reduced to 30%, the nidation index was about 0.6. Tubal function of the untreated oviduct was nearly normal (nidation index 0.8) two weeks after surgery.

[Endoscopic sterilization reversal]. / Endoskopische Refertilisierung.

In animal experiments a new technique for tubal reanastomoses has been developed, applicable endoscopically. The first results in humans indicate that this new technique may be an alternative to "classical" microsurgery in selected cases. But more data are necessary to evaluate the role of this new method in the field of reconstructive tubal surgery.

An experimental model for pelviscopic tubal anastomoses.

An endoscopic technique for tubal anastomosis has been developed in a rat uterine horn model. Uterine segments were anastomosed endoscopically in a training device for surgical pelviscopy ('Pelvitrainer') by fibrin glue, using an inlaying splint as a guide. The anastomoses were accomplished by a seromuscular 6-0 suture at the anti-mesenteric border. Morphological studies revealed good patency of the anastomosed segments without stenoses or occlusions. The tissue continuity was good. In only two cases out of the 20 studied was a tapering of the uterine wall found adjacent to the anastomosis. It is concluded that this endoscopic technique for tubal anastomosis presents a useful alternative to classical microsurgical reversal of sterilization by laparotomy.

The effect of fibrin glue and peritoneal grafts in the prevention of intraperitoneal adhesions.

We studied the effect of fibrin sealant and peritoneal grafts applied by fibrin glue on adhesion formation in the rat. Sealing and patching of ischaemic lesions of the uterus resulted in a significant increase in adhesion formation. We conclude, that fibrin sealant and peritoneal grafts can not be given general approval for prophylaxis of intraperitoneal adhesions.

[Peptidergic (NPY, NT, VIP, SP, CGRP) innervation of the functional systems of the uterus and fallopian tube in the human]. / Peptiderge (NPY, NT, VIP, SP, CGRP) Innervation der funktionellen Systeme des Uterus und der Tube des Menschen.

With the use of immunohistochemistry NPY-IR, NT-Ir. VIP-IR, SP-IR and CGRP-IR nerve fibers were localized in the human uterus and oviduct. Each peptide showed a characteristic distribution pattern and the respective nerve fibers innervated in distinct manners the different target cell systems, i.e. surface epithelium, vasculature and smooth muscle layers. The functional implications of our results are discussed.

[Regulatory peptides of the uterine tube in the human]. / Regulative Peptide in der tuba uterina des Menschen.

In the human oviduct the occurrence and distribution of nerves containing substance P(SP), neurotensin (NT) and neuropeptide Y(NPY) immunoreactivity has been analysed previously. In vitro application of synthetic NT and SP resulted in dose-dependent excitatory effects on the different parameters of oviductal motility (resting tension, force and amplitude of spontaneous contractions). While NPY alone was found to exert no effects, it antagonized the action of acetylcholin. Thus, our results indicate that NT and SP may have a neurotransmitter and NPY a neuromodulator function in the regulation of oviductal motility.

[Fibrin glue anastomoses of the uterine tube using various experimental conditions]. / Fibrinklebeanastomosen der tuba uterina unter verschiedenen experimentellen Bedingungen.

Morphology and fertility was studied in 40 female New Zealand White rabbits after reanastomosis of the fallopian tube with fibrin glue and conventional microsurgical techniques. Isthmic anastomoses with and without resection of tubal segments as well as ampullary anastomoses were investigated. Gluing was as effective as microsuturing. Morphological studies demonstrated good healing of the oviduct. Gluing of ampullary segments, however, seems to increase the risk for dehiscence and formation of tubal fistulas at the site of anastomosis.

Morphology and fertility after re-anastomosis of the rabbit fallopian tube with fibrin glue.

Morphology and fertility were studied in 20 female New Zealand White rabbits after re-anastomosis of the Fallopian tube with fibrin glue and conventional microsurgical techniques. All oviducts were patent postoperatively. No intraperitoneal adhesions were observed. There were no significant differences with regard to the number of corpora lutea, implantations and the nidation index. Morphological studies demonstrated a normal fold pattern and ciliation at the side of anastomosis in the sealed oviducts as well as in the sutured oviducts. No intraluminal fibrin deposits were found. For re-anastomosis of the Fallopian tube with fibrin glue, splinting is necessary. In some instances this may be related to a mucosal trauma. However, under optimal conditions the use of fibrin glue is equivalent to conventional microsurgical anastomosis of the oviduct. For tubocornual, ampullary--ampullary and isthmic--ampullary anastomoses with luminal disparity, fibrin glue seems to be inappropriate.

[Puerperal uterine inversion]. / Die Inversio uteri puerperalis.

Inversion of the uterus is a rare but dangerous postpartal complication. Morbidity and Mortality depend to a significant degree on early diagnosis and treatment. When the condition is detected early manual reposition and simultaneous shock therapy, which are usually possible, are of prime importance. Antibiotic prophylaxis should always be instituted in order to prevent any upward spread of infection. With appropriate obstetric management subsequent births can be uncomplicated, as in the case described by the authors.

Immunohistochemical and biological evidence for a neuromodulator function of neuropeptide Y in the human oviduct.

By means of the peroxidase-antiperoxidase technique the existence of neuropeptide Y-immunoreactivity (NPY-IR) in nerve fibers of the normal human uterine tube was established. NPY-IR fibers are found to supply vascular and non-vascular smooth muscles of the uterine tube. In both systems the density of NPY-IR nerves is markedly high. The NPY-IR nerves exhibit a predominance for the arterial portion of the oviductal vasculature in the serosal, the muscle and the mucosal layer. Furthermore in the mucosal layer, some NPY-IR fibers occur in contact with the surface epithelium. In-vitro experiments with helical strips of the human uterine tube reveal no significant effects of NPY alone of the different parameters (resting tension, frequency and amplitude of spontaneous contractions) of mechanical activity while it seems to act in combination with acetylcholine. Thus, the distinct innervation patterns of the NPY-IR nerve fibers as well as the results obtained by bioassay may suggest a neuromodulator function of this neuropeptide in the human uterine tube. In this respect, NPY may play an important role in the transport of the eggs through the tube.