Significance of endovaginal ultrasonography in assessing tamoxifen-associated changes of the endometrium. A prospective study.

BACKGROUND: A prospective study was conducted investigating the value of endovaginal ultrasound in the assessment of tamoxifen-associated changes of the endometrium in patients with breast cancer. METHODS: Seventy postmenopausal patients with breast cancer treated with anti-estrogens for at least 6 months were entered. Those with bleeding disorders and/or an endometrial thickness of > or =10 mm found on ultrasonography underwent hysteroscopy and dilatation and curettage (D&C) for further histological evaluation. In 22 patients, positive ultrasound findings could be compared with histopathology. RESULTS: 82% of the 22 patients with positive sonographic findings had a glandular-cystic hyperplasia or a glandular-cystic polyp. No adenomatous hyperplasia or endometrial cancer was observed in our series. CONCLUSION: Vaginal ultrasound represents a useful diagnostic tool to detect tamoxifen-associated changes of the endometrium. A threshold of 10 mm endometrial thickness appears suitable to identify endometrial abnormalities while reducing the rate of false-positive findings to an acceptable level. However, the role of vaginal ultrasound in screening for endometrial cancer or premalignant lesions remains uncertain.

[Preoperative axilla sonography in breast tumor suspected of malignancy--a diagnostic advantage?]. / Präoperative Axillasonographie beim malignitätsverdächtigen Mammatumor--ein diagnostischer Gewinn?

PURPOSE: To assess the value of preoperative axillary sonography possibly malignant for breast tumours. METHOD: We performed preoperative axillary sonography on 89 patients with suspicious breast tumours. In 78 cases, among which there were 74 invasive carcinomas, the surgery that followed included an axillary lymph node dissection and a comparison with the histology was possible. RESULTS: The sonographic detection of axillary lymph node metastases has a sensitivity of 90% and a specificity of 91.7% in relation to all tumour stages and a sensitivity of 100% and specificity of 89.6% in relation to T1 tumours. In our analysis, therefore, it is vastly superior to a clinical examination of the axilla. CONCLUSION: Ultrasonography is an accurate imaging method for the diagnosis of axillary lymph node metastases. Broadening this analysis to include more patients will validate this conclusion. The results of our preliminary study suggest that this diagnostic method could help reduce unnecessary radical surgery in the treatment of breast cancer.

[Vacuum punch biopsy under digital stereotaxic control, a new procedure in percutaneous diagnostic incision and excision biopsy of mammographic findings: initial experience]. / Vakuumstanzbiopsie unter digitaler Stereotaxie--ein neues Verfahren zur perkutanen diagnostischen Inzisions- und Exzisionsbiopsie mammographischer Befunde--erste Erfahrungen.

PURPOSE: To evaluate a digital, stereotactically controlled vacuum punch biopsy method. MATERIAL AND METHOD: In 60/61 female patients a vacuum punch biopsy (14 G) was performed under digital stereotactic control; by means of a single biopsy 1-2 cm3 of tissue was obtained. In one patient the examination could not be carried out because of insufficient microcalcification. Excision biopsies were performed because of doubtful microcalcification (24), focal lesions (35) or abnormal tissue architecture (1). RESULTS: 48 of the biopsies proved benign, 2 showed dysplasias, 5 in situ and 5 invasive carcinomas. In all cases the histological and radiological diagnoses were in agreement. The possibility of a non-presentative biopsy could be excluded with a high degree of certainty because of the accurate localisation and the coherent tissue samples; this produced significant increase in diagnostic certainty. Subsequent haematomas seen mammographically (58/60) are smaller (1-1.5 cm) than for conventional percutaneous punch biopsies because of the effect of suction. The examination was well tolerated (there were no significant haematomas and no infection). Problems consisted of one case of bleeding (due to little experience) and one incorrect localisation which was immediately recognised. DISCUSSION: If the high degree of accuracy, which is expected, can be confirmed, the procedure would appear suitable for replacing diagnostic operative biopsies of non-characteristic mammographic finding.

[Occlusion of a vesicovaginal fistula with Latzko-repair]. / Verschluss von Blasen-Scheidenfisteln durch Latzko-Plastik.

UNLABELLED: The Latzko procedure is a well-known method for the closure of small vesico-vaginal fistulas occurring in the vaginal dome after hysterectomy. This method is favoured by gynaecologists. In three Departments of gynaecology, a total of 104 patients were treated. 76% had been referred from other hospitals. 56.7% resulted from gynaecological operations. In 69.2% was a benign and in 28.8% a malignant disease. In only 2 cases, the primary disease remained unknown. RESULTS: In 97 of 104 (= 93.3%) cases, the procedure according to Latzko succeeded at the first attempt. 5 of 7 recurrences were resolved by the second attempt with the same operative technique according to Latzko, signifying a secondary success rate of 98%. There were only 2 notable complications: the one, where a postoperative bladder haemorrhage attributed to anticoagulants, and the second with a bladder stone noticed 11 years after the Latzko procedure. This technique can be performed in 95% of all vesico-vaginal fistulas occurring. The fundamental advantages of its use are: short duration of the procedure, high cure rate and few complications.

[Urinary fistula after radical hysterectomy with lymph node excision]. / Harnfisteln nach radikaler Hysterektomie mit Lymphonodektomie.

In 908 radical hysterectomies including dissection of pelvic lymph nodes, 13 (= 1.43%) urogenital fistulas were seen. They occurred postoperatively between the 7th and 15th day. In 12 cases it was a uretero-vaginal and once a vesico-vaginal fistula. The operation report of 7 cases with uretero-vaginal fistula reveals difficulties in separating the ureter in its prevesical part proceeding from tumour spread, endometriosis, scar or bleeding. Since 1985 a percutaneous nephrostomy has been performed (5 cases). 4 fistulas were cured spontaneously, one of them had a percutaneous nephrostomy. In all cases, urography was normal. In 7 cases, ureterocystoneostomy had to be performed. This was done once with fixation of the psoas muscle and 6 times according to Boari. All patients were cured without any complications and with an undisturbed drainage assessed 1 year later by urography. 1 patient, who refused any follow-up, died subsequently. The only vesico-vaginal fistula has been closed by Latzko's procedure. In recent years the problems concerning urogenital fistulas resulting from surgery of cervical cancer have receded. However, if patients adopt an offensive attitude against surgical therapy of stage T2b, the rate of incidence of this complication can be expected to increase.

[Myofunction in players of wind instruments]. / Myofunktion bei Blasinstrumentenmusikern.

Within the framework of a longitudinal study, tongue function was examined for maximum pressure, force/time ratio and motility with the aid of a force, pressure and impulse transducer in 181 pupils playing wind instruments and 120 control persons. The methods designed for this purpose provided a reproduction of tongue performance during the act of blowing a wind instrument. The results of this study show statistically significant differences between persons who play wind instruments and those who do not and players of other types of instruments. The data derived from these results permit statements about the degree of muscular malfunction among players of wind instruments. Furthermore, they are helpful in the assessment of therapeutic success or failure.

[Diagnosis of angiologic function in unilateral leg edema following combined treatment of cervix cancer]. / Angiologische Funktionsdiagnostik beim einseitigen Beinödem nach kombinierter Therapie des Zervixkarzinoms.

For the clarification of the genesis of a unilateral dropsy of the legs which had appeared in 16 women after operative and radiologic therapy of a carcinoma of the cervix apparative angiological functional investigations were carried out. A slightly diminished plethysmographic drainage volume in a Doppler-sonographically unhandicapped deep venous flow off corresponded to the clinical picture of the secondary lymphatic oedema. The findings were compared with the behaviour of the parameters in thrombosis of the iliofemoral vein and test persons with healthy vessels. Only in two cases a venous component in form of a stenosis of the pelvic veins and a postthrombotic syndrome, respectively, could be objectified. Since the methodology renders possible a differentiation of lymphatic oedema and phleboedema, it is suitable for non-invasive controls of the course and has practical significance in the after-care of female patients with carcinoma of the cervix.

[Estrogen and progesterone receptors in mesenchymal structures of the female urogenital tract]. / Estrogen- und Progesteronrezeptoren in mesenchymalen Strukturen des weiblichen Urogenitaltraktes.

In 37 women being operated on gynecologically small portions of mesenchymatic tissue have been sampled and analysed with respect to the presence and concentration of estrogen and progesterone receptors within the cytosol fraction. The proofs were taken from: ligamentum cardinale, ligamentum sacrouterinum, pubo-vesico-cervical fascia, paracolpium, ligamentum teres uteri, levator muscle and serving as a comparison tissue from fornix vaginae posterior. In the proofs of pubo-vesico-cervical fascia and paracolpium there were no progesterone receptors. In all the other tissues there were as a matter of principle estrogen and progesterone receptors. However from sample to sample there were wide differences with reference to the existence and the concentration of hormone receptors. There was no correlation to the age of life. The results are discussed and compared with those to be found in literature. MeSH: D 12.776.543.750.830.630 Receptors, estrogen G 6.184.154.803.817.349 Receptors, estrogen G 12.803.817.349 Receptors, estrogen D 12.776.543.750.830.700 Receptors, progesterone G 6.184.154.803.817.777 Receptors, progesterone G 12.803.817.777 Receptors, progesterone A 5.360.319.114.170 Broad ligament A 5.360.319.114.803 Round ligament

[Actinic bladder-rectal-vaginal fistulas]. / Zum Problem der aktinischen Blasen-Mastdarm-Scheidenfisteln.

Combined fistulas between urinary bladder, rectum and vagina are one of the most serious complications after radiation therapy of genital carcinoma in female patients. The prognosis quo ad restitutionem is poor also at the present time. In our material of 25 cases the restoration of complete faecal and urinary continence was achieved in only 5 patients, however with a loss of the ability of sexual intercourse. In 5 cases an ileum conduit combined with an anus praeter was the definitive solution and in 4 further cases the hygienic situation was improved by colpocleisis and vesico-rectal anastomosis, respectively. In the other patients only a palliative and symptomatical therapy was possible because of poor condition, advanced age and unfavourable local situation.

[Latzko-plasty for closing vesicovaginal fistulas]. / Die Latzko-Plastik zum Verschluss von Vesikovaginalfisteln.

It is reported on 68 Latzko-grafts in vesicovaginal fistulae. In 63 cases (92.6%) the closure was successful in the first session; 4 of the 5 failures were corrected with the same technique in the second session. The method is technically simple and little stressing for the patient. It is to be recommended particularly for the treatment of the typical posthysterectomy fistula. The shortening of the vaginal canal is insignificant also in young women.

[Melanoma of the female urethra]. / Melanom der weiblichen Harnröhre.

Case report of a 69-year-old woman with a melanoma of the urethra. Radical surgery was renounced in regard of the age. We performed local excision with inguinal lymphonodectomy only followed by chemotherapy with dacarbazine. A tumor of this localisation is rare. Approximately 45 cases have been described in the literature at present. The prognosis of the diseases is very poor.

[Urometric studies before and after stress incontinence operations]. / Urometrische Untersuchungen vor und nach Stressinkontinenzoperationen.

77 women with insufficiency of the urethral sphincter were urometrically examined before and 16 weeks after operations for urinary stress incontinence (38 vaginal plastic operations and 39 Zoedler plastic operations). The resting pressure in the urethra cannot be increased by either operation. On the contrary, the readings are lower after the operations. A slight increase in the functional length of the urethra is to be observed only in the case of Zoedler plastic operations. The so-called stress quotient shows the clearest change. This increases in both groups and corresponds to clinical healing. The results are compared with more recent, partly divergent findings.

The antenatal use of ambroxol (bromhexine metabolite VIII) to prevent hyaline membrane disease: a controlled double-blind study.

A prospective double-blind clinical trial was carried out to determine whether ambroxol (bromhexine metabolite VIII) treatment (1000 mg/day for a period of 5 days) reduces the risk of hyaline membrane disease (HMD) in potentially premature infants. Amniocentesis was performed before the first and 24 h after the last application of ambroxol or placebo to assess the development of the total phospholipid phosphorus content, the L/S ratio, the P/S ratio, and the properties of the surface tension of the amniotic fluid after ambroxol or placebo. There were 246 infants born to 224 mothers. Of the 116 infants with less than or equal to 36 completed weeks' gestation, 56 were in the ambroxol and 60 in the placebo group. No differences between groups occurred in risk factors for HMD (diabetes, asphyxia, male sex, cesarean section). Statistically significant differences in favor of the infants in the ambroxol group were found in the HMD incidence: 23.2% in the ambroxol group compared with 41.7% in the placebo group (p less than 0.05). There was no reduction of the HMD incidence in the less than or equal to 32-week gestational age category in the ambroxol group compared with the placebo group inspite of the fact that all the examined parameters for determining lung maturity reflected a stimulatory effect of ambroxol compared with the results of the placebo group, particularly before the 33rd week of gestation. Prolonged rupture of the membranes played no protective role against HMD.

[Anamnestic and urometric classification of 185 cases of urinary incontinence]. / Anamnestische und urometrische Klassifikation bei 185 Fällen mit Harninkontinez.

Standard interviews were obtained from 185 women with urinary incontinence over three years to collect information about their individual complaints. All probands then were urometrically examined. The selection had been by negative criteria, as 40.5 per cent of the women had undergone one or several unsuccessful operations earlier in the past. Information based on case histories was grouped by three categories of complaint; only stress symptoms (n = 66), stress and urge symptoms (n = 116), only urge symptoms (n = 3). The following findings were obtained, in terms of ICS classification, by urometric diagnosis: stress incontinence due to urethral insufficiency (n = 51), stress incontinence with accompanying urge component (n = 72), sensorial urge incontinence (n = 26), motor urge incontinence (n = 16), overflow incontinence (n = 7), no urometric findings (n = 13). Sizeable variation was found to exist by comparison between complaint groups on the basis of case history and groups based on urometric classification. Such discrepancy applied primarily to the grey area of combined stress-urge symptoms from which the majority of bladder-dependent incontinence forms was recorded. Yet, pure stress incontinence, too, signalized genuine urethral insufficiency only in 51 of 66 cases. Hence, even detailed case history can provide only limited information for proper diagnosis.

[Pregnancy and delivery after renal transplantation (author's transl)]. / Schwangerschaft und Geburt nach Nierentransplantation.

A case report is given on a 21-years-old woman who became pregnant 18 months after renal transplantation. In spite of relatively unfavourable conditions (match 0,25; hypertension) renal function showed a good adaptation throughout the gestation. In the 38. week of pregnancy the woman was successfully delivered of a 2440 g healthy female child by vacuum extraction. There were no effects of the immunsuppressive drugs on the newborn. It is the third case of a successful delivery after renal transplantation in the GDR.

[Action of some drugs on pressure profile of female urethra (author's transl)]. / Wirkung einiger Pharmaka auf das weibliche Urethradruckprofil.

The action of certain drugs upon the urethra of clinically intact women was studied by measurement of the urethral profile. beta-adrenoreceptor stimulating and blocking agents, such as fenoterol, propanolol, as well as cholinergics, including carbachol and pyridostigmine, failed to exercise any effect on the urethral pressure profile. On the other hand, anticholinergics, such as atropine and N-butylscopolammonium-bromide, diazepam, and chlorpromazine, produced significant decrease in both maximum urethral pressure and maximum urethral closure pressure. N-butylscopolammonium-bromide and chlorpromazine also shortened the functional length of urethra. Drop of all parameters relating to the urethral pressure profile was observed to take place in response to application of succinylcholine. Phentolamine, an alpha-adrenoreceptor blocking agent, then was administered and caused further reduction of those parameters. The pressure values were elevated by ketamine. The above findings are discussed and compared to present concepts published in literature on medicamentous control of urethral function.

[The carbachol test on the determination of detrusor denervation following extended hysterectomy]. / Der Karbachol-Test zur Bestimmung der Detrusordenervation nach erweiterter Hysterektomie.

Following radical hysterectomy the urinary bladder develops a denervation supersensitivity to cholinergic stimulation. The carbachol-test based on that observation: after filling the bladder with 100 ml sterile saline and subcutaneous administration of 0,004 mg.kg-1 body weight carbachol the course of the intravesical pressure was recorded. Normal bladders respond with a pressure rise non exceeding 15 cm H2O. Between 15 and 20 cm H2O is a suspicous zone. Test results of more than 20 cm H2O indicate a denervated bladder with increasing certainty. 6 healthy women and 50 patients underwent radical hysterectomy were examined. In 20 women measurements before and after the operation were performed. The carbachol-test is semiquantitative only. In patients with bladder dysfunction we found predominant pathological test results. But there is no evident correlation between the level of the test result and the clinical degree of the micturition disturbances. In some cases the effects of the detrusor supersensitivity on the urethra and the ureter were examined. The conditions of the denervated bladder call for caution in the administration of cholinergic drugs.