[Age specific and age corrected mortality in gynecological carcinoma--including breast carcinoma]. / Altersspezifische und alterskorrigierte Mortalität gynäkologischer Karzinome--einschl. Mamma-Karzinom.

Quality of life and life span are parameters which characterise a successful tumour diagnosis and therapy. We found out that the age-specific death rate and standardised death rate concerning gynaecological cancers and carcinoma of the breast in Bavaria increased and we compared different years. The standardized mortality ratio increased between 1977 and 1990 from 91 to about 108% Neither diagnostics using update equipment nor an individualised therapy improved the situation. The slightly increasing incidence rate does not explain the present rate of deaths in cancer. An important factor is the younger age and the endocrine situation of women at the time of the primary disease. 50% of our patients are less than 55 years old and pre- or perimenopausal. Estrogen-gestagen combinations used in contraceptives and hormone replacement therapy (HRS) seem to have a stimulating effect (Henderson). The significant decrease in cervical cancer is encouraging, but does not compensate the increase in breast cancer. No significant change is seen in ovarian cancer.

[Injury to the surgeon in treatment of an HIV infected patient]. / Verletzung des Operateurs bei der Behandlung einer HIV-Infizierten.

The number of HIV-infected female patients undergoing surgery is increasing. Injuries of the surgeon can never be completely excluded. The risk of HIV infection via a needle puncture lesion is estimated to be approximately 0.4%. Besides the well-known protective measures, careful wound disinfection followed by HIV tests for a period of up to six month after the lesion are indicated. It is indeed high time to consider the patient HIV test as a matter of course, not least because it is our duty to be concerned also about the health of our co-workers and staff directly engaged in patient care.

Nipple discharge and abnormal galactogram. Results of a long-term study (1964-1990).

In case of abnormal nipple discharge of the female breast, galactography can detect variations of ductal calibre, intraductal alterations and ductal discontinuities. Between 1964 and 1990 we examined 2588 women by galactography and performed 826 duct excisions. In one out of 8 patients (13.4%) we diagnosed invasive carcinoma or ductal carcinoma in situ. In more than 40% a solitary ductal papilloma was detected. 13.7% of the patients were found to have extensive intraductal solid papillary or adenomatous epithelial proliferations. Comparison with collected statistical data reveals that other investigators are able to detect malignant changes in 1-23% of cases. We have managed the largest number of cases and have diagnosed pathologic ductal secretion in more than 3% of women we screened by physical inspection, mammography and sonography. The colour of the ductal discharge is of minor importance, as histologic analysis is mandated by the presence of ductal system alterations.

[Life expectancy of clinically occult breast cancer. Study of a comparative patient sample since 1975]. / Lebenserwartung bei klinisch okkultem Brustkrebs. Untersuchung an Vergleichskollektiven seit 1975.

We have been observing 2 groups of 50 female patients with occult or clinical breast cancer each of whom was initially treated at the Gynaecologic Hospital of the University of Erlangen-Nürnberg between 1975 and 1978. During the follow-up period, 2 patients out of the group of occult cancer and 13 out of the group of clinical carcinoma died of their primary disease. Four women out of the group of occult cancer and 3 from the group of "clinical carcinoma" have developed recurrences. The differences in survival times according to Kaplan-Meier are immense, even if they are not significant owing to the small number of patients. But it is difficult to obtain and to evaluate larger groups of patients and longer follow-up periods due to the low percentage of occult cancer (7.7 to 10.5% only). There are 30 women out of the group of occult breast cancer living without relapse after an observation period up to 15 years. 27 patients out of the group of "clinical cancer" have not shown any evidence of recurrence up to now. This small difference after such a long follow-up period can be explained by the general life expectancy and by the age at initial treatment.

Resection guided by antibodies (REGAJ): a diagnostic procedure during second-look operation in ovarian cancer patients.

A hand-held probe has been used to localise the 131I-labelled antibody OC125 during second-look operation (SLO) in 22 ovarian cancer patients. In six patients microscopic cancer was detected with the procedure and a further six patients with areas of increased radioactivity during SLO developed recurrent disease within 1-4 months. We suggest examining resection guided by antibodies as a possible means of removing antigen-producing cancerous tissues during surgery.

[Primary metastasizing fallopian tube carcinoma. Case report and overview of current therapy]. / Primäres, metastasierendes Tubenkarzinom. Kasuistik und Ubersicht über die aktuelle Therapie.

Case report a primary metastasizing carcinoma of the fallopian tube with radical operation and 4 cycles of antineoplastic chemotherapy (cisplatin and treosulfan). Tumor markers decreased to normal level following primary treatment and the first chemotherapy cycle. After six months we did and immunoscintigraphy and second-look-laparotomy including the Regaj-procedure. There was a histological complete remission. Additionally we give a review about cytostatic treatment of this cancer the last then years. Radical operation combined with adjuvant chemotherapy is said to be successful.

[Breast cancer: age and tumor diameter. Partial results of a long-term study since 1966]. / Brustkrebs: Lebensalter und Tumordurchmesser. Teilergebnisse einer Langzeitstudie seit 1966.

From 1963 to 1985 approximately 2,800 patients underwent primary treatment for breast cancer at Erlangen University Gynecological Clinic. In the same period just under 60,000 women underwent thorough clinical, mammographic, and in some cases sonographic examination. In the last 20 years the age of patients with breast cancer has shifted toward the younger age groups. Peak incidence is found among 40 to 49-year-old and 60 to 64-year-old women. The data indicate that women should undergo screening for breast cancer from the age of 35 on, and in high-risk cases from age 25. The majority of the carcinomas are 1-2 cm in diameter. This has not changed in the last 10 years. Only in every tenth patient is the tumor less than 1 cm in diameter.

[Contrary trends of treated carcinomas of the cervix and breast. Observations in a hospital with a relatively low population mobility between 1963 and 1982]. / Gegenläufige Tendenzen behandelter Zervix- und Mammakarzinome. Beobachtungen einer Klinik mit verhältnismässig geringer Bevölkerungsmobilität zwischen 1963 und 1982.

In a clinic serving a district area with a rather constant population the number of clinical carcinomas of the cervix dropped during the past two decades, whereas during the same period the number of carcinomas of the breast which were clinically identifiable showed a four-fold increase. The diagnostic criteria are comparable. No explanation for this development trend can be offered. It is the aim of the authors to stimulate consideration of this phenomenon and to suggest collection of comparable data which might be helpful in finding an explanation.

[More than 1500 radiologically indicated breast biopsies. Microcalcifications and the pathologic galactogram, 1964-1982]. / Mehr als 1500 radiologisch indizierte Mammabiopsien. Mikrokalk und pathologisches Galaktogramm, 1964-1982.

In the last 19 years 47,518 women had mammographies at the Department of Gynaecology of the University of Erlangen. 1653 patients had 2215 galactograms. Biopsies of the breast indicated by mammography were done in 1521 cases. 955 cases showed micro-calcifications in groups. 566 showed abnormal galactograms. The microscopic examination in the 955 cases with microcalcifications showed invasive carcinoma, carcinoma in situ or atypical epithelial proliferations in 1/3 of the cases In 10% of the cases small calcified fibroadenomata, papillomas or granulomas were found. In 60% of the biopsies mammary dysplasia partly with nonatypical epithelial proliferations were found. When the galactogram showed pathological contours the breast tissue was excised in a segment. In over 40% of 566 segmental excisions papillomata were the cause of pathological secretions from the breast. Ductal carcinomas, carcinoma in situ and extensive intraductal solid papillary or adenomatous epithelial proliferations were found in 27% of the cases. Approximately the same number of cases did not show atypical epithelial proliferations. Delay in the early diagnosis of changes which may be the first sign of malignant breast disease can be avoided by good cooperations between the physicians treating the cases.

[How 67 carcinomas of the breast with a maximal microscopic diameter of 10 mm were recognized]. / Wie 67 Mammakarzinome mit einem histologisch bestimmten Maximal-durchmesser von 10 mm erkannt wurden.

67 breast cancers with a maximum diameter of up to 10 mm on the histological section were retrospectively analysed according to the primary situation for medical consultation and the way to cancer diagnosis. 46 women presented themselves with clinical signs. 19 women had an anamnestical risk, whereas only two women were without any risks or symptoms. 34 tumourspecific clinical signs are followed by 25 tumourspecific mammograms. Eight small invasive carcinomas were detected only under the microscope, two of them in mastectomy specimens. Even small cancers, therefore, are mostly diagnosed from the patients themselves. The contribution of mammography is tremendous. Intensified systematic histological examination of biopsies and mastectomy specimens is mandatory especially in high risk patients.

[The importance of mammography in relationship to the number of treated carcinomas of the breast. Partial results from 1976--1978 of a long term study (author's transl)]. / Bedeutung der Mammographie bezogen auf die Zahl aehandelter Karzinome. Teilergebnisse (1976--1978) einer langfristigen Studied.

From 1976 to 1978 11, 197 women were examined clinically and mammographically. Biopsy material from 1,673 breasts were examined microscopically. In 536 cases, or almost every third case (32%), a carcinoma of the breast was detected. The cancer was bilateral in 19 cases and the total number of women was therefore 517. A clinically occult tumour was only found in 7.7% (40 of 517) of the cases. 5% of these patients were high risk patients and 2.7% preventive examinations. 5 women with occult carcinoma of the breast were under age 40 and 14 under age 50. Benign changes of the glandular tissue were found in 59.5% of the cases. Marked proliferative changes were found in 4.6% of the cases and carcinoma in situ was found in 3.8% of the patients. In the age group 45--54 benign and proliferative changes of the parenchyma occured almost twice as often as cancers. The ratio between benign and malignant findings was 1:1 in the age group 55--59 and was less than 1:2 in the age group over 70. A sophistication of the mammograhic technique must be obtained. A thorough microscopic examination of tissue from subcutaneous mastectomies and tissue obtained at the time of reduction mammoplasties showed occasionally unexpected malignant tissue in an unexpected location. Especially these cases are suitable for later comparison to the mammographies.

[Image quality in film and xero mammography. Second paper. Reproduction of medium range contrast (author's transl)]. / Untersuchungen zur Bildgüte bei der Film- und Xeromammographie. 2. Mitteilung: Wiedergabe mittlerer Strahlenkontraste.

In our first paper we dealt with the reproduction of low contrast ranges during the radiological examination of the breast. In the present paper we are concerned with medium contrast ranges, using a semi-objective procedure. This again depended on visual evaluation of test films of grids with variable grid ratios. For mammography rotating molybdenum and tungsten tubes with various filters were available. The advantages of xere radiography in rendering detail were less marked in these medium contrast ranges. The disadvantage of scatter is again less marked, but the resolution of non screen film for small and medium-sized objects is considerably greater. However, xero-radiography, using a tungsten tube with 0.5 mm. Al. filtration represents a satisfactory compromise between image quality and radiation dose for the demonstration of small and medium contrast ranges.