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Biomedical subjects

A H Graf

Publications and source records attributed to A H Graf.

At least 37 records · Page 2Linked to original sources
PubMed1997

Pregnancy after ovarian stimulation and intrauterine insemination in a woman with cavernous macrohemangioma of the liver. A case report.

BACKGROUND: There are only a few reports on cavernous hepatic hemangiomas after hormonal substitution or during pregnancy. So far, there have been no publications on ovulation stimulation in such patients. CASE: We report on a 31-year-old, asymptomatic, healthy woman with an incidental ultrasound finding of a cavernous macrohemangioma (diameter, 14 cm) of the liver. For treatment of primary infertility, clomiphene citrate therapy had been administered repeatedly in the past. Because these treatments were not successful and andrologic subfertility existed, homologous intrauterine insemination was recommended. The first treatment cycle with clomiphene citrate, human chorionic gonadotropin and subsequent intrauterine insemination was successful. During pregnancy, 2.5-cm growth of the liver hemangioma and a smaller, second lesion occurred but remained asymptomatic. Primary cesarean section was performed at 37 weeks' gestation to prevent rupture or hemorrhage of the hepatic hemangioma. Macrohemangiomas of the liver are associated with the risk of rupture and severe hemorrhage due to pressure during pregnancy and delivery. CONCLUSION: During ovulation stimulation, pregnancy and the immediately postpartum period, there was no change in this benign tumor.

Adult↗
PubMed1996

An evaluation of the Filshie clip for postpartum sterilization in Austria.

Voluntary sterilization is a popular method of family size limitation. Among other techniques for surgical induction of female sterility, the application of various kinds of clips to the Fallopian tubes has been introduced. The Filshie clips consist of rubber-lined titanium and their use for interval sterilization has been repeatedly published. So far, there are only a few reports regarding the use of Filshie clips during the postpartum period, when tubes are edematous and more friable. Therefore, 300 women voluntarily requesting postpartum surgical sterilization for the purpose of family size limitation were enrolled into a prospective trial. Within 72 h of delivery, 282 women were sterilized under general anesthesia using a subumbilical minilaparotomy approach and Filshie clip application. Of these women, 251 were available for follow-up examination at 6 weeks, 240 at 6 months, 234 at 12 months, and 209 at 24 months after the sterilization procedure. Complication rates were low, and there were no pregnancies during the follow-up period. These results indicate that the application of Filshie clips is a safe and efficacious method of surgical female sterilization in the postpartum period.

Adult↗
PubMed1996

Localization and distribution of vasoactive neuropeptides in the human placenta.

Neuropeptides play an important role in the regional regulation of blood flow and hormone secretion. Few studies report the presence of peptides in the human placenta. Our experiment evaluates neuropeptides in the human placenta using immunocytochemical techniques. Representative tissue sections from full-term placentae were fixed immediately after delivery and processed into paraffin sections or frozen. They were treated with multiple immunofluorescence, streptavidin-biotin-peroxidase complex and immunogold-silver staining techniques in combination with well-established monoclonal and polyclonal antibodies, using appropriate absorption controls to ensure the validity of the staining. Vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), neuropeptide tyrosine (NPY), galanin, somatostatin, met-enkephaline, helodermin and substance P-like immunoreactivities were demonstrated within decidual cells. Endothelin-1 was found in both trophoblasts and endothelial cells. Peptide immunoreactivities in the human placenta especially at the decidual interface between mother and fetus supports a role for the diffuse neuroendocrine system (DNES) in the regulation of placental blood flow critical for fetal growth and development.

Calcitonin Gene-Related Peptide↗
PubMed1996

[Risk and prevention of thromboembolism complications in gynecologic malignancies].

Gynecologic malignancies are often associated with deep vein thrombosis and pulmonary embolism, even before treatment is begun. But such complications also happen during treatment, also if thromboembolism prophylaxis is performed. The incidence of pulmonary embolism before treatment was investigated using scintigraphy. In a retrospective and in a prospective randomized trial, various methods of thromboembolism prophylaxis were evaluated during primary or postoperative radiation therapy. Pulmonary embolism was present in 11.9% of the patients admitted with uterine malignancy. Retrospectively, there were deep vein thromboses in 6.8%, pulmonary embolisms in 3.8% and bleeding complications in 5.3% of the patients receiving thromboembolism prophylaxis with acenocoumarol during radiation therapy of cervical and endometrial cancer. In the prospective study, deep vein thromboses occurred in 1.5%, pulmonary embolisms in 5.9% and bleedings in 2.2%, with both the LMW heparin and the acenocoumarol groups presenting similar results. Thromboembolism is a frequent paraneoplasia of uterine malignancies. The prevention of thromboembolic complications during radiation therapy of uterine malignancies is efficacious and safe using either LMW heparin or acenocoumarol.

Acenocoumarol↗
PubMed1995

Prognostic impact of DNA content and AUER classification in primary fallopian tube carcinoma.

DNA ploidy has been studied in 61 primary fallopian tube carcinomas using image-cytometry. The investigation also included survival analysis, and ploidy classification according to AUER was performed in order to evaluate its prognostic impact for fallopian tube carcinoma. A high number of aneuploid cases were observed (79% aneuploid vs. 21% euploid tumors). The high incidence of aneuploid tumors was consistently observed among all FIGO-stages as well as all groups of histologic grading. There was no correlation between ploidy and FIGO-stage or histologic grading. Patients with euploid DNA content showed a median survival of 34 months compared to 24 months for aneuploid cases (log-rank, P = 0.83). No correlation between the AUER classification and FIGO-stage or histologic grading could be observed. Tumors with an AUER type I and II (75th quantile 41 months) showed a better outcome than tumors with AUER III and IV (75th quantile 19 months). Although these results did not reach statistical significance (P = 0.07), a trend could be observed. Therefore AUER classification may be useful as an objective prognostic parameter. The high incidence of aneuploid tumors could be an expression of the high biologic aggressiveness of primary fallopian tube cancer which has been repeatedly mentioned in the past.

Adenocarcinoma↗
PubMed1995

Helospectin and pituitary adenylate cyclase activating polypeptide in the human vagina.

Helospectin and pituitary adenylate cyclase activating polypeptide (PACAP), both recently isolated from the poisonous saliva of the American lizard or from ovine hypothalamus respectively, belong to the same peptide family as vasoactive intestinal polypeptide (VIP), peptide histidine methionine (PHM) and glucagon. In the present study, occurrence and distribution patterns of nerve fibers containing helospectin- and PACAP-like immunoreactivity in the human vagina were investigated by immunohistochemistry. Double immunofluorescent labeling showed that helospectin or PACAP are co-expressed with VIP and PHM within subpopulations of VIP-immunoreactive nerve fibers. Nervous structures containing helospectin and VIP were particularly numerous in the internal mucous lining of the vagina and in free epithelial nerve endings, and an abundant network of nerve fibers surrounding blood vessels was detected. Nerve fibers co-expressing PACAP and VIP were more numerous than those expressing helospectin and VIP and were mainly found in close association with blood vessels as well as beneath and within the epithelium. Due to the lack of non-rabbit helospectin or PACAP antibodies, possible co-localizations between these two peptides could not be investigated at this time. The localizations demonstrated suggest possible roles of the two peptides in the regulation of local blood flow and lubrication of the vagina.

Adult↗
PubMed1995

Three-dimensional ultrasound in prenatal diagnosis of skeletal dysplasia.

A lethal form of bone dysplasia, platylospondylic lethal chondrodysplasia, was diagnosed prenatally using three-dimensional ultrasound. The various types of three-dimensional imaging mode provided diagnostic details not available by conventional two-dimensional ultrasound. The diagnosis was made after referral in the 23rd week of gestation, allowing termination of pregnancy due to the poor prognosis. Prenatal sonograms were compared with postnatal radiographs.

Adolescent↗
PubMed1995

The relationship between peak velocity in the fetal descending aorta and hematocrit in rhesus isoimmunization.

OBJECTIVE: To correlate the peak velocity in the fetal descending aorta, as measured by pulsed Doppler ultrasound, with fetal hematocrit values assessed by funipuncture in pregnancies complicated by rhesus isoimmunization. METHODS: One hundred twelve consecutive funipunctures were performed on 33 rhesus-negative gravidas of 21-36 weeks' gestation (median 30). Doppler flow, corrected for angle, was measured on the fetal descending aorta with pulsed Doppler equipment immediately before funipuncture. Differences between observed peak velocities and the calculated gestational age-dependent upper confidence limits (delta peak velocities) were compared with corresponding differences between observed hematocrits and the calculated lower confidence limits (delta hematocrits), and a regression analysis on the above paired difference values was performed. In addition, the correlation coefficient between delta peak velocities and delta hematocrits was calculated for the first procedure per pregnancy only. RESULTS: The mean peak aortic velocity of anemic fetuses was higher than that of unaffected fetuses (P < .001); delta peak aortic velocities correlated negatively with delta hematocrits (r = -0.66, P < .001). The correlation coefficient between delta peak aortic velocities and delta hematocrits for the first procedure peer pregnancy only was r = -0.72 (P < .001). Prediction of fetal anemia by Doppler using gestational age-dependent 95% confidence limits was possible with positive and negative predictive values of 73 and 66%, respectively. CONCLUSION: Peak aortic velocity, a noninvasive assessment of fetal anemia, may be used as an additional test for monitoring pregnancies complicated by rhesus isoimmunization. However, the limited predictive capacity hampers its clinical usefulness.

Anemia↗
PubMed1995

Preoperative CA 125: an independent prognostic factor in patients with stage I epithelial ovarian cancer.

OBJECTIVE: To evaluate the prognostic importance of preoperative CA 125 levels in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer in comparison with the established prognostic factors: degree of differentiation, FIGO substage, and age. METHODS: In a retrospective analysis, the traditional prognostic factors and CA125 levels (cutoff value 65 U/mL) were studied in 201 patients who were treated in five centers during 1984-1993. Patients with borderline tumors or non-epithelial ovarian carcinomas were excluded, as were women in whom CA 125 had not been determined preoperatively. RESULTS: In univariate analysis (Mantel test), overall survival decreased significantly in patients positive for CA 125 (P < .001). Substage (P = .004) and histologic grade (P = .01) also significantly influenced survival prognosis. When the effects of preoperative CA 125 levels were correlated with histologic grade, all three subgroups with CA 125 levels equal to or greater than 65 U/mL were associated with a decreased survival probability (grade 1, P = .04; grade 2, P = .003; grade 3, P = .01). Multivariate analysis (Cox model) identified preoperative CA 125 as the most powerful prognostic factor for survival (P < .001), the risk of dying of disease being 6.37 times higher (95% confidence interval 2.39-16.97) in CA 125-positive patients. Although FIGO substage retained its significant influence on survival (P = .03), histologic grade and age were not prognostically important. CONCLUSION: Randomized trials investigating the efficacy of adjuvant treatment in patients with FIGO stage I epithelial ovarian cancer should also include stratification by preoperative CA 125 levels.

Age Factors↗
PubMed1995

Proliferative activity in ectopic trophoblastic tissue.

Clinical observations have shown that tubal pregnancies develop individually different biological activities such as different growth rates, levels of beta human chorionic gonadotrophin (beta-HCG), or rates of tubal wall destruction. In the present study, we evaluated the proliferative activity of ectopic cytotrophoblastic tissue using immunocytochemistry with antibodies to Ki-67 (clone MIB-1). The rates of proliferation obtained were related to the maternal serum beta-HCG values. Reference data were obtained from placentas of intact intrauterine pregnancies (group I, n = 14). The proliferative activity of this tissue was compared to that of cytotrophoblastic tissue of tubal pregnancies (group II, n = 27). Ki-67-immunostained as well as non-stained cytotrophoblastic nuclei of the villi and the trophoblastic columns were counted separately, and results were expressed as percentage of positive cells. Serum beta-HCG values were determined twice, 48 h and immediately before operation. The cytotrophoblastic cells of intact intrauterine pregnancies (group I) showed uniform and high proliferative activities (80% on average in villi, 84% on average in columns). The average Ki-67 proliferation rate was significantly lower (P < 0.001) in trophoblastic tissue of tubal pregnancies (group II; 42% on average in villi, 61% on average in columns). Within the group of tubal pregnancies, higher intragroup differences were observed. The number of Ki-67-labelled cells was independent of the absolute preoperative serum beta-HCG values in both groups, yet they were clearly related to the relative increase of beta-HCG in maternal serum. At higher proliferation rates, there was a significant, growing increase of beta-HCG values (P < 0.01). We have found immunohistochemical evidence to support the previous clinical speculations that tubal pregnancies develop more heterogeneously and more slowly than intact intrauterine pregnancies. The development of the beta-HCG concentrations may be taken as an indirect parameter, reflecting proliferative activity of the trophoblast.

Cell Division↗
PubMed1994

DNA ploidy in primary fallopian-tube carcinoma using image cytometry.

Determination of DNA ploidy in 61 samples of primary Fallopian-tube carcinoma (FTC) by use of image cytometry is presented. Of these samples, 48 showed an aneuploid DNA content. Patients with euploid DNA content showed a median survival time of 33.8 months compared to 24.5 months for aneuploid cases. A high incidence of aneuploid tumors was consistently observed among all FIGO stages and in all groups of histologic grading. However, no correlation between ploidy and FIGO stage or histologic grading could be demonstrated. This observation could be regarded as a marker for the high aggressiveness of FTC which has been repeatedly described in the past.

Adult↗
PubMed1994

Does endoscopic sphincterotomy destroy the function of Oddi's sphincter?

OBJECTIVE: To evaluate the possible destruction of Oddi's sphincter by endoscopic sphincterotomy (ES). DESIGN: Prospective, nonrandomized control trial. The study was done from the beginning of 1986 to the end of 1991. SETTING: The Department of Surgery, Salzburg (Austria) General Hospital. PATIENTS: Ninety-one patients with cholecystolithiasis and concomitant different diseases of the common bile duct. Ninety-five patients exclusively having cholecystolithiasis served as the control group. INTERVENTIONS: Patients with cholecystolithiasis plus concomitant different diseases of the common bile duct underwent preoperative ES and, at a second intervention, conventional cholecystectomy. Patients with cholecystolithiasis only underwent elective conventional cholecystectomy. MAIN OUTCOME MEASURES: During the cholecystectomy, three pressure and flow variables were routinely measured in the common bile duct: the natural resting pressure, the maximum pressure after the standardized injection of physiologic saline solution, and the normalizing time (the time required for the reappearance of the initial resting pressure). RESULTS: The statistical comparison of the two groups showed no significant deviations regarding the resting pressure (P < .4), whereas the maximum pressure was significantly lower (P < .01) in the group that underwent ES. The normalizing time of patients who underwent ES was not statistically different (P < .375) from that of the control group patients. CONCLUSION: The function of Oddi's sphincter is changed but not destroyed following ES.

Adolescent↗
PubMed1994

Prognostic factors in primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.

A retrospective nationwide evaluation of primary fallopian tube carcinomas for a period of 10 years (1980-1990) was performed to evaluate the prognostic impact of various factors. Sixty-six cases were investigated for the prognostic influence of estrogen (ER) and progesterone (PgR) status, mitotic activity, degree of nuclear anaplasia, and inflammatory reaction. ER and PgR receptors were detected by immunohistochemistry from paraffin sections. Forty-two percent were PgR-positive and 26% were ER-positive. However, no correlation of steroid receptors with survival could be found. Ninety-two percent of all tumors showed a moderate and high degree of nuclear anaplasia and only 8% showed a low degree of nuclear anaplasia. Thirty-four (52%) samples from all patients revealed low mitotic activity compared to 32 (48%) with an intermediate and high mitotic rate. Twenty-four (37%) tissue samples showed a positive inflammatory reaction which correlated with a significantly better outcome compared with tumors without this feature. This finding was also confirmed in multivariate analysis as an independent prognostic factor.

Fallopian Tube Neoplasms↗
PubMed1994

First trimester three-dimensional ultrasound volumetry of the gestational sac.

First trimester amniotic fluid is an ultrafiltrate of maternal plasma and constitutes the major component of gestational sac volume (GSV). We hypothesized that GSV, assessed by 3-dimensional (3-D) ultrasound volumetry, would reflect function of the early uteroplacental unit and therefore provide a basis for predicting pregnancy outcome. We tested this hypothesis in 38 pregnancies which had first trimester GSV measurements by two investigators thus allowing determination of interobserver variation. Gestational age (GA) was based on a careful history and conventional 2-dimensional ultrasound measurements. Serum for beta-hCG, estradiol (E2) and progesterone (P) was obtained at the time of ultrasound examinations. "Normal" outcome was defined as confirmation of a viable fetus. "Abnormal outcome" was defined as either a "blighted ovum" or embryonic demise. Statistical analysis was performed by Independent t-test and regression analysis. There were 31 "normal" and 7 "abnormal" pregnancies studied between 5 and 11 weeks gestation (mean +/- SD 8.3 +/- 1.3 weeks). GSV was significantly correlated to GA (r = 0.74, P < 0.001), higher than to beta-hCG (r = 0.40, P = 0.034), E2 (r = 0.70, P < 0.001) and P (r = 0.21, P = 0.334), respectively. In the abnormal group 2/2 pregnancies with a twin sac had a GSV within 1 SD of the mean. 3/5 cases of missed abortions or blighted ovum had a GSV < 2 SD of the mean. The interobserver correlation was high (r = 0.99, P < 0.00f2p4This is the first clinical study investigating the diagnostic use of 3-D ultrasound volumetry in first trimester pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗
PubMed1994

Preoperative and postoperative CA-125 serum levels in primary fallopian tube carcinoma.

Levels of CA-125 were determined pre- and postoperatively in 13 patients with fallopian tube cancer. Values before surgery were significantly higher (Median 1220 IU/ml, 90-5000 IU/ml) compared with postoperative levels (Median 194 IU/ml, 67-880 IU/ml) (P = 0.0052). Correlation analysis with FIGO stage and grading failed to show any statistical significance, but a trend for a positive correlation with FIGO stage and preoperative values could be observed. The CA-125 antigen is expressed by fallopian tube carcinoma and should therefore be used in diagnosis and follow-up.

Adenocarcinoma, Mucinous↗
PubMed1994

A comparative analysis of management and prognosis in stage I and II fallopian tube carcinoma and epithelial ovarian cancer.

Staging and surgical as well as post-operative treatment of primary Fallopian tube carcinoma (FTC) followed the lines established for primary ovarian cancer (OC). In a nationwide retrospective analysis we were able to find a distinct difference between these two tumours. A total of 262 patients, 68 with FTC and 194 with OC, in stage I and II were included into this study. A univariate as well as a multivariate analysis for survival was performed, including factors such as age, histological type, grading and surgical and adjuvant treatment. A significantly poorer outcome (P = 0.0002) for FTC patients with a 5-year survival of 50.8% compared with 77.5% for OC patients was observed. This finding was persistent and independent of any investigated factor, in univariate as well as multivariate analyses. Therefore, we feel that a more aggressive therapeutic approach to the treatment of FTC even in early stages can be recommended. On the other hand, the retrospective character of our study has to be taken into account.

Age Factors↗