[Neonatal results of prgenancies in overweight and obese mothers at the University of Würzburg Gynaecology Clinic--a comparison of the years 1980 and 2005]. / Neonatales Ergebnis von Schwangerschaften übergewichtiger und adipöser Mütter an der Universitäts-Frauenklinik Würzburg - ein Vergleich zwischen 1980 und 2005.

BACKGROUND: The prevalence of overweight and obesity in pregnant women has increased during the last decades (in our examination period from 10.9 to 29.8 %). Maternal obesity is a risk factor for pregnancy, delivery and the newborn. Does the neonatal outcome of pregnancies with maternal overweight and obesity in 2005 differ from that in 1980? METHODS: All patients with a body mass index (BMI) > 25 kg / m (2) who delivered in 1980 (n = 130) and in 2005 (n = 392) at the University Hospital Würzburg were evaluated retrospectively. The neonatal result of singletons born at term was studied (1980: n = 125; 2005: n = 315). RESULTS: The rates of macrosomia > 4500 g (5.6 vs. 1.3 %) and shoulder dystocia (4.8 vs. 0.3 %) declined significantly. No significant differences were found regarding the mean newborn weight (3560 vs. 3508 g), weight percentile (55.5 vs. 56.4 %), length (51 cm), head size (35 cm), fetal distress (3.2 vs. 3.8 %), respiratory insufficiency (3.2 vs. 2.2 %), 5-min-Apgar (9.77 vs. 9.69) and arterial umbilical cord pH (7.27 vs. 7.26). Birth weight was not associated with the degree of obesity in 2005 compared to 1980. CONCLUSION: Despite the increasing prevalence and severity of obesity in pregnant women most parameters of neonatal outcome did not change. The observed relative rate of macrosomia and shoulder dystocia declined, but the case number of these complications is still relevant. Obviously obstetricians have responded appropriately to the changing risk profile.

Risk factor adapted treatment of Hodgkin's lymphoma: strategies and perspectives.

In a national multicenter trial in the Federal Republic of Germany, patients with Hodgkin's lymphoma in stages I, II and IIIA presenting with large mediastinal tumor (MT), extranodal (E), or massive spleen (S) involvement received a combined modality treatment with 2x (COPP + ABVD) followed by 20 or 40 Gy EF radiation (HD1 protocol). By October 1987, 89 patients aged 15-60 years had finished therapy and were evaluable for response. Of these 74 (83%) achieved complete remission (CR). After 3 years freedom from treatment failure (FFTF) is 80% (+/- 8%, 95% confidence interval) and survival (SV) 92% (+/- 6%, 95% confidence interval). In a univariate and multivariate analysis using FFTF as endpoint we could not identify any particularly prominent prognostic risk factor among the following examined: stage, constitutional symptoms, MT, E stage, S involvement, age, sex, histology, laparotomy, erythrocyte sedimentation rate (ESR), leukocytes, lymphocytes, and alkaline phosphatase (AP). These data suggest that the inclusion criteria have selected a fairly homogeneous group of patients with respect to prognosis. In a separate trial (HD3 protocol) patients in stages IIIB/IV received induction chemotherapy with 3x (COPP + ABVD). Patients in complete remission (CR) received consolidation therapy by either radiotherapy (20 Gy IF) or further chemotherapy (COPP + ABVD). Patients not in CR received salvage therapy (40Gy in the case of persisting nodal disease, or else 4x CEVD chemotherapy). By October 1987, 137 patients had finished therapy and were evaluable for response. Of these 86 (63%) achieved CR after induction chemotherapy. Including salvage therapy a total of 104 patients (76%) achieved CR. After 3 years FFTF is 56% (+/- 10%, 95% confidence interval) and SV 84% (+/- 8%, 95% confidence interval). Univariate and multivariate prognostic risk factor analyses were performed using FFTF as endpoint. Sex, age, stage, splenectomy, bone marrow, and liver and bone involvement had no prognostic impact. In contrast, a pretreatment erythrocyte sedimentation rate (ESR) above 80 mm/h and a serum alkaline phosphatase (AP) above 230 IU/ml each appeared as significant prognostic factors (P less than 0.01; relative risk, 2.3). The two parameters can be combined to separate two groups (A: ESR and AP both low; B: ESR and/or AP high) which differ significantly for FFTF (P less than 0.001) and survival (P less than 0.04). The decision for risk-adapted treatment requires identification of groups of patients in the frame of specified diagnostic and therapeutic strategies.(ABSTRACT TRUNCATED AT 400 WORDS)

[Bone marrow transplantation for aplastic anaemia (author's transl)]. / Knochenmarktransplantation bei aplastischer Anämie.

From March 1975 until May 1980 twelve patients with severe aplastic anemia were grafted with bone marrow from HLA-identical siblings by the Munich Cooperative Group for Bone Marrow Transplantation. Six patients are alive between 10 months and more than 5 years after grafting with normal blood values and marrow. One patient is treated as an out patient for chronic localized graft-versus-host disease (GvHD), five patients are well and without treatment. Six patients have died, one patient with a cerebral hemorrhage the day before transplantation, three patients following rejection of grafts 32, 40 and 55 days after grafting, one patient with severe GvHD 85 days after grafting and one patient, probably with interstitial pneumonia, following cerebral hemorrhage. Three of 6 patients who were conditioned with Cyclophosphamide (CY) only died following rejection of the graft. Two adults who were conditioned with CY and "total lymphoid irradiation" and three children, who wer given unirradiated leukocyte concentrates from the marrow donor after grafting, did not reject their grafts. The results of the Munich-Cooperative Group for Bone Marrow Transplantation are comparable to those of large, specialized centers for bone marrow transplantation, they indicate possibilities of cure of severe aplastic anemia by marrow grafts from HLA-identical siblings. They confirm that better results are obtained with earlier transplantation in the course of the disease.