Progressive hearing loss in hearing impaired children: immediate results of antiphlogistic--rheologic infusion therapy.

OBJECTIVE: The question whether progressive sensorineural hearing loss during childhood is the fateful course of a main illness has been discussed controversially over 60 years. No medicamentous therapy with satisfactory results has been described in the literature. The goal of this study was to determine whether an infusion therapy, developed for the treatment of sudden hearing loss in the elderly, can induce recovery after progression in sensorineural hearing loss during childhood. METHODS: Out of 20 children suffering from acute progression in sensorineural hearing loss, seven children were treated with an infusion therapy containing prednisolone, pentoxifylline and a plasma expander (group I), and 13 children were not treated (group II). All children were advised not to use hearing aids for 6 weeks. RESULTS: In group I, we observed partial to complete restoration of hearing threshold towards the original hearing threshold given by previous routine controls in 6/7 children. In group II, only three children recovered, with the state of ten children's' hearing loss remaining unchanged. The long-term follow-up, however, showed no distinct difference in either group. CONCLUSION: Infusion therapy can be helpful when treating acutely progressing sensorineural hearing loss during childhood. The benefit for communicative competence has to be discussed. Further studies should be conducted.

[The value of aspiration cytology within the scope of triple diagnosis of palpable breast changes]. / Der Stellenwert der Aspirationszytologie im Rahmen der Tripel-Diagnostik tastbarer Mamma-Veränderungen.

The diagnostic value of aspiration cytology and the overall diagnostic quality of the so-called triple test (aspiration cytology, mammography and physical examination) in the evaluation of palpable breast masses were investigated in a retrospective study. 608 histologically evaluated cancers and 224 benign lesions were investigated. A main purpose of the study was to find out whether the triple diagnostic test can replace surgical biopsy and thereby reduce the number of unnecessary biopsies. All lesions triple-diagnosed as malignant were histologically proved to be malignant, i.e. there were no false positive results. The rate of false negative results was found to be within the range reported for false negative results in fresh frozen sections. Based on these results we state that the dogmatic statement "every palpable mass in the breast must be excised" should be replaced by the recommendation "every palpable mass must be assessed and clarified". A great number of retrospectively unnecessary biopsies can be avoided by a systematic use of the triple diagnosis. The diagnostic safety of this method is close to that of open biopsy. In all cases where positive or negative concordant triplets are found, histological confirmation by biopsy can be avoided. Patients with benign lesions can be thoroughly followed up by repeated physical and radiological examinations. Patients with triple diagnostic malignant results can be adequately treated. Lesions for which triple diagnosis yields neither benign nor malignant, must be biopsied: This is also necessary in all cases with suspicious findings in mammography without a palpable mass, if the equipment for stereotactic or ultrasound- guided biopsies is not available.(ABSTRACT TRUNCATED AT 250 WORDS)

[The nuclear surface area as a malignancy parameter in breast cancer]. / Die Kernflächengrösse als Malignitätsparameter beim Mammakarzinom.

For better characterisation of the degree of malignancy of breast cancers, we have attempted to establish a correlation between nuclear size and prognosis in breast cancer. Karyometric investigations were carried out on biopsies from 200 primary breast cancers. On the basis of the nuclear areas determined, we were able to distinguish three groups of carcinomas: group I: carcinomas with small nuclear areas (n = 33), mean value 97.76 microns 2, group II: carcinomas with intermediate nuclear areas (n = 98), mean value of the nuclear areas 146.5 microns 2, group III: carcinomas with large nuclear areas (n = 69), mean value 190.8 microns 2. After five years, 6% of the patients in group I had died, as compared to 35% in group II and 48% in group III. The median survival time was 45 to 48 months in group I, as compared to 37 months in group II and 28 months in group III. There was a direct correlation between axillary lymph node status and nuclear size: the carcinomas with the small nuclear sizes showed the least involvement. A comparison of the prognostic relevance of nodal status and nuclear area size, reveals a good relevance for the nuclear area similar to that of the nodal status. The results of the biopsy cytology are already available to the surgeon before the operation.

Long-term follow-up in patients with mammary gland changes found unsuspicious by aspiration cytology.

Between 1971 and 1981, 2,184 female patients with mammary gland changes were examined using the triple diagnosis approach (clinical finding, mammography, aspiration cytology) and were found unsuspicious for cancer. Seven of these patients (0.32%) in a follow-up were found to harbor cancer. In view of these findings it is felt acceptable to postpone immediate surgical intervention in case of negative results of the triple diagnosis approach provided there is a reliable performance of these diagnostic methods and a close follow-up in these patients.

Determining the nuclear area in normal breast epithelia and in the nuclei of mammary carcinomas.

In view of the great variation in the size of epithelial cell nuclei in benign changes in the mammary gland, the cytologist is often faced with diagnostic difficulties. Clear differences in the size of the nuclei in aspiration biopsies from the mammary glands of pregnant women and those from the mammary glands of post-menopausal women seem to indicate that even in normal, unchanged mammary gland epithelia, the cell nuclei size varies in accordance with the hormonal situation and any functional changes that might have occurred. To test these findings, the nuclear area of the mammary gland epithelia was compared in four groups consisting of 20 post-menopausal women, 20 sexually mature women, 20 gravid women and 20 women taking ovulation inhibitors. In addition, we measured the nuclear area of tumour cell nuclei from solidly growing mammary carcinomas and their hybrid forms. The 40 patients with mammary carcinomas included 20 sexually mature women and 20 post-menopausal women. A comparison of the size of the nuclei of normal epithelial cells revealed distinct differences in each group. The only exceptions were the sexually mature women and the women taking ovulation inhibitors, between whom there was no significant difference. The average nuclear area in post-menopausal women was 48 micron 2, in sexually mature women 75 micron 2, in pregnant women 118 micron 2, and in women taking ovulation inhibitors 79 micron 2. The difference between the size of the nuclei in the tumour cells and those in normal mammary gland epithelia was significant in all groups. The average size of the tumour cell nuclei in sexually mature women was 185 micron 2, and in post-menopausal women 170 micron 2. A major difference between the two tumour groups was the noticeably larger range in the size of the nuclear area in the sexually mature women.

In vitro studies of human breast carcinoma cells obtained by aspiration biopsy.

Cells from 14 human breast carcinoma were obtained by aspiration biopsy and used for in vitro cultivation. Growth could be observed in three cultures, which were derived from solid, partly adenoid growing tumors with metastases in the axillary nodes. The growth started after 2--6 days in culture and lasted 2--4 weeks. No permanent line could be established.

Oral contraception can decrease the pituitary capacity to release gonadotrophins in response to synthetic LH-releasing-hormone.

PIP: Measurements of plasma levels of LH and FSH before and after injection of LH-releasing hormone (LH-RH) in women who have been on oral contraceptives, to determine whether the release of FSH and LH is affected by the chronic administration of oral contraceptives were donducted. 5 women, ages 24-34 years, who were taking oral contraceptives for 12-36 months, were studied, between Days 22 and 24 of the cycle. They received 12.5 mcg LH-RH on Day 1 and 25 mcg on Day 2 of the study. LH and FSH were measured by radioimmunoassay using the double-antibody method. 5 control women were also used. In all 5 control volunteers, serum LH rose rapidly within 5 minutes after the injection of 12.5 mcg LH-RH. In 4 out of 5 cases, an increase of plasma FSH was demonstrable after application of LH-RH. The increments were smaller than for LH. With the 5 women on oral contraceptives, much lower basal values of LH and diminished FSH levels were found. When the 5 test women were injected on Day 2 with 25 mcg LH-RH, the amounts of LH and FSH released were not significantly different from those of Day 1. The amounts of LH and FSH released in response to the intravenous administration of LH-RH were found to be severely impeded in 4 out of 5 women taking oral contraceptives for long periods of time. Long-term administration of oral contraceptives seems to limit the reserve capacity of the pituitary to release gonadotropins.^ieng