Biomedical subjects

D Heberling

Publications and source records attributed to D Heberling.

At least 19 recordsLinked to original sources

PubMed1990

Value of endometrial biopsies and serum hormone determinations in women with infertility.

Premenstrual endometrial biopsies were performed in 324 infertile women. Their hormonal status was established in the early follicular phase of the same cycle (FSH, LH, oestradiol-17 beta, testosterone, DHEAS, TSH and prolactin, the latter two both basally and following TRH stimulation). In the luteal phase, oestradiol-17 beta and progesterone concentrations were determined three times between the fifth and tenth hyperthermic days, as was prolactin, both basally and following metoclopramide stimulation. All pregnancies occurring before January 1986 were recorded. Seventy-five per cent of the biopsies were evaluated on the expected ovulation date from the basal temperature charts, 77% according to the next onset of menstruation. Twenty-six per cent of the biopsies were out of phase, and 7% displayed abortive secretion. A significant correlation existed between endometrial profiles and the characteristics of the cycle, stimulated TSH and prolactin levels, and with testosterone and FSH concentrations. No correlation of the endometrial status with midluteal oestradiol or progesterone concentrations was found. While various hormones of both the follicular and luteal phases correlated significantly with the pregnancy rate, the same was not demonstrated for the state of endometrial biopsy. Therefore, following exclusion of organic explanations of infertility in women with biphasic cycles, the determination of progesterone and oestradiol-17 beta in the luteal phase was considered. In women with reduced concentrations of these hormones, androgens, gonadotrophins, prolactin and TSH should be determined. Endometrial biopsy is valuable only if pregnancy fails to occur, despite therapeutically normalized hormone concentrations.

Adolescent↗

PubMed1989

DNA flow cytometry, clinical and morphological parameters as prognostic factors for advanced malignant and borderline ovarian tumors.

Patients with malignant ovarian (n = 111) and borderline (n = 8) tumors (FIGO stage III/IV) underwent surgery and chemotherapy and were analyzed clinically (age, residual tumor after surgery) and morphologically (type, grade, psammoma body content), and by means of flow cytometry (DNA ploidy, S-phase fraction). Follow-up was 12-72 months for investigation of survival. Patients under 60 years of age (n = 18) with malignant tumors showed longer survival than patients over 60 (n = 93) (P = 0.078). Residual tumor was relevant for prognosis in malignant tumors only if macroscopically there was no residual disease (n = 13). There were no significant differences between residual tumors less than or equal to 2 cm (n = 61) and greater than 2 cm (n = 37). WHO typing was of little importance for survival analysis. Compared to borderline tumors (n = 8), serous (n = 65), endometrioid (n = 13), nonclassifiable (n = 12), mucinous carcinomas (n = 8), and nonepithelial tumors (n = 12) had a poor prognosis. Psammoma bodies were found in 25 patients with serous carcinomas, 7 of them had a high content. The prognosis for these 7 patients was much better than that for patients with a moderate or low psammoma body content (P = 0.006). Twenty-three epithelial tumors were graded G1, 28 were G2, and 47 were G3. However, grading was considered only as a prognostic factor in serous carcinomas (n = 65) (P = 0.028). A total of 199 DNA histograms from 119 patients were analyzed by flow cytometry (FCM). There were no correlations between tumor type and DNA ploidy or S-phase fraction. Seven of eight borderline tumor and all serous carcinomas with a high content of psammoma bodies were diploid combined with a low (less than or equal to 4%) S-phase fraction. DNA ploidy and S-phase fraction were excellent prognosticators. Of 99 epithelial malignant tumors, 35 were diploid and 64 were aneuploid. An S-phase fraction less than or equal to 4% was found in 39 patients, 4.1-10% in 73 patients, and greater than 10% in 23 patients. Diploid tumors and tumors with a low S-phase fraction showed the best survival (P = 0.007, resp. 0.0001). Our study emphasizes the importance of an accurate histology, including information on psammoma body content, and the importance of DNA flow cytometry. The advantage of FCM is that the results are simple, reproducible, and objective.

Age Factors↗

PubMed1988

[Ultrasonography in the primary diagnosis and follow up of ovarian tumors].

Preoperative sonographic data in 317 patients who underwent surgery at the University Women's Clinic Heidelberg for an ovarian tumour during a 6 years' observation period, were compared with the results of clinical examination. The prognostic value of both techniques was examined, by relating the findings (as to tumour size, demarcation from the uterus) to the postoperative histological or cytological diagnosis. In the 214 cases of benign and 103 of malignant ovarian tumours a correct diagnosis was provided by ultrasound in 88% and 74% respectively. Thus significantly more often than by clinical examination alone (p less than 0.001 for benign and p less than 0.01 for malignant tumours). The sonographic findings in 49 patients during follow-up after surgery for ovarian carcinoma and polychemotherapy were checked by a second look laparotomy. The detection rate of tumour progression, recurrence, residual tumour or remission was of 98%.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

[Vascular abnormalities of the umbilical cord--incidence, significance and possibility for prenatal ultrasonic detection].

Vascular anomalies of the umbilical cord are amongst the most frequent congenital malformations, their incidence being 0.2% to 1.4%. As a result of the latter the risk of occurrence of other malformations and chromosomal anomalies is markedly elevated. Between January 1977 and July 1987 a total of 78 cases (0.51%) of umbilical cord vascular anomalies were recorded at the Department of Gynaecology of the University of Heidelberg. Malformations occurred in 37% of the foetuses involved. 28% showed retarded growth and 9% had an abnormal set of chromosomes. Anomalies of the urinary tract and malformations of the thoracic organs were very frequent. Total mortality after the 28th pregnancy was about 14%. Currently available high-resolution real-time ultrasound equipment can show up even prenatally pathological variations of the umbilical vascular pedicle (e.g. a single umbilical artery). Because of the manifold risk involved, routine ultrasound control is recommended. If this anomaly is diagnosed, the pregnancy should be classified and treated immediately as a high-risk pregnancy.

Abnormalities, Multiple↗

PubMed1985

[Carcinoma formation in a neovagina following vaginoplasty].

A carcinoma occurs only very rarely in a neovagina. This extremely rare occurrence is a suitable example of an exogenous carcinogenesis. Only 6 cases have so far been reported in literature. The clinical and morphological features are discussed on the basis of the author's own observations on one of his patients.

Adult↗

PubMed1985

[Sonographic diagnosis of severe fetal malformations].

The present paper reports on results of ultrasonographic examination in the identification of severe congenital malformations in the period between 1975 and 1982. The incidence of severe congenital malformations in relation to the total number of births during this period was 159 out of 11,372 (1.4%). In 144 cases with severe malformations at least one antenatal ultrasonographic examination had been performed. According to their topographic location, 42% of these were head/neural tube defects, 38% trunk/organ defects, only 2% were severe defects of the extremities and 18% were rare fetal malformations. As a result of previous ultrasonographic examinations at specialists' practices 60% of the cases were referred to the authors' clinic for further clarification with a correct diagnosis or a suspected fetal malformation. Of all the sonographically demonstrable structural defects of the fetus, 81% of all severe fetal defects seen at the authors' clinic during the period in question were identified correctly. If the observation period is divided into the years 1975 to 1979 and 1980 to 1982, there is a striking rate of increase in the number of antenatal ultrasonographic diagnoses which were correct, from 71% in the first period to 86% between 1980 and 1982. Most of the false-negative ultrasonographic findings were congenital cardiac abnormalities, since up to that point no special fetal echocardiographic examinations had been performed. In the entire period covered by the investigation there was only one false-positive finding ("Potter's syndrome"). Forty-six per cent of the ultrasonographically demonstrated severe fetal malformations were diagnosed before the end of the 24th week of pregnancy, and 54% after the end of the 24th week of pregnancy. Only in 60 out of 141 cases (43%) with severe fetal malformations was the quantity of amniotic fluid found to be normal; 26% of the cases had hydramnios and 31% oligohydramnios. Pathologic movement behaviour had been registered ultrasonographically in 43% of the cases with severe fetal malformations; biometric dimensions of the biparietal cranial diameter and the transverse diameter of the thorax (greater than 10th percentile to 90th percentile, according to the percentile growth curves of Schmidt, 1982) corresponding to gestational age had only been measured in 30% and 50%, respectively, of the cases with fetal malformations. During the entire period covered by the investigation, from 1975 to 1982, only 16 children born at term (between the 38th and 42nd weeks) had severe malformations which had not already been diagnosed.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗

PubMed1985

[Diagnosis of benign and malignant ovarian tumors].

The present paper reports on the value of gynecological-clinical examinations and preoperative ultrasonography in the diagnosis of benign and malignant ovarian tumors. Out of a group of 42 patients, in all of whom "ovarian cyst" had only been diagnosed clinically, 14% were not found to be suffering from this condition at surgery. In a comparison of preoperative gynecological-clinical and ultrasonographic findings (in 68 patients) it proved possible to determine the side on which the tumor was localized, its actual size, the extent to which it was delimited from the uterus, and its consistency (whether solid or cystic) significantly better by ultrasonography (p less than 0,01). However, the results of this study indicate that 2% of the cases diagnosed ultrasonographically as "benign ovarian tumor/ovarian cyst" are likely to be ovarian carcinomas. In the group of patients with malignant ovarian tumors also (42 patients), there was a significant difference in the preoperative diagnosis "suspected ovarian carcinoma". On the basis of clinical findings it was only diagnosed in 45%, while it was found in 74% by ultrasonography (p less than 0,01). In 3 cases with ovarian carcinoma there was no pathologic palpation finding, and in only one other case was a "suspected ovarian cyst" diagnosed. By means of ultrasonography, on the other hand, all of the cases of ovarian carcinoma were classified either as "ovarian carcinoma" or as "cystic-solid/complex abdominal tumor". The most frequent diagnoses on the basis of the sonographic scan (approx. 90%) were cystic-solid ovarian tumors, followed by cystic-ventriculated ovarian tumors with solid portions and finally solid ovarian tumors with only a few cystic portions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

[Clinical and patho-anatomic aspects of metastases of breast cancer].

The importance of carcinoma of the breast in female malignancies demands a critical examination of the condition of metastases by means of certain clinical and pathological data. The clinical data and the results of autopsies of 384 patients with breast carcinoma were examined. The frequency and the chronology of occurrence of metastases put out metastases of lymphnodes , skeleton, lung, liver and local recurrences. The importance of the mediastinal lymph node metastases in the distribution of metastases in thoracical organs was established and is discussed. The relation of frequency of the metastases to primary tumour staging (TNM) shows a 63% rate of metastases in patients with No and 86% in patients with N+. A comparison of two decades (I = 1960-1969; II = 1970-1979) shows certain trends 1. In decade II more patients with primary stage T1-T2 NoMo were found in autopsies having less metastases. 2. More local recurrences and metastases of genital organs were diagnosed. 3. In decade II more "late-metastases" (2-10 years after primary diagnosis) were found. These developments are explained by better primary diagnostic methods, more frequent follow-up examinations after primary therapy, and more frequent application of secondary therapies (chemotherapy, radiotherapy).

Adenocarcinoma↗

PubMed1984

[Potentials and limits of conventional differential diagnosis of the endometrium].

The reproducible identification of various histological types of the endometrium is of special interest for many reasons. The controversy in endometrial classification and terminology led us to study the algorithm of conventional endometrial diagnosing. This study is to examine the significance of historical morphologic parameters for differential diagnosis by semiquantitative or binary recording and computer-assisted evaluation. The results are based on cross-tables and cluster-analysis. The statistical test showed that most of the historical parameters were neither adequate for reclassification nor exclusion of historical typing of the endometrium. An objective and reproducible classification of endometrial changes by using binary parameters can only be achieved for specific histological types of normal endometrium and several types of hyperplastic endometrium. The dedifferentiated carcinoma is a diagnosis "per exclusionem ", since nearly all of the binary parameters cannot be analysed. The individual borderline lesions cannot be differentiated from each other by descriptive parameters. They cannot even be distinguished from the highly differentiated endometrial carcinomas. This kind of differential diagnosis is obviously not based on conventional formalistic criteria but on nonquantifiable empirical data. This might be a reason for the above mentioned controversy in endometrial diagnosis and terminology.

Diagnosis, Differential↗

PubMed1983

[Clinical aspects of extrauterine pregnancy].

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Adult↗

PubMed1983

[Therapy in metastasizing ovarian cancer--survival rate correlated with histological and cytological grading as prognostic factors].

The histologic grading especially of the modified Broders'-Grading is a suitable prognostic factor in Ovarian Carcinoma. Our investigations show this to be especially true after failure with first line chemotherapeutic agents. These morphologic gradings should especially be used for the selection for high risk patients and for the treatment planning in ovarian carcinoma.

Adult↗

PubMed1983

[Considerations on computer-assisted pattern recognition in the endometrium].

Histomorphological diagnosing very much depends on subjective empiric data. In histomorphology of the endometrium nomenclature as well as diagnostic classification lack uniformity and are full of controversy in literature. This results in opposing assessments of dignity of endometrial hyperplasias and prognosis of varying grades of carcinoma differentiation. One of the reasons is the lack of objective and reproducible diagnostic categories, not yet found. Morphometry with so-called computer-assisted interactive pattern recognition systems might offer the solution to numerous problems. Since there are no specific parameters for diagnostic identification of endometrial hyperplasias and carcinomas, only a combination of sensitive and reproducible parameters can allow for diagnostic identification. We report on our first computer-assisted pattern recognition studies and results that appear to provide an adequate basis for leaving descriptive diagnosing and turning to objective diagnosing. Such an objective diagnosing might not only be of clinical and therapeutic significance but also provide a new evaluation of the today's significance -- still full of controversy -- and prospective potency of endometrial hyperplasias. In computer-assisted interactive pattern recognition also lies the possibility of a contribution to objective tumour grading that appears to have high prognostic significance.

Diagnosis, Computer-Assisted↗

PubMed1983

[Clinical demands on the morphologist in the area of surgical gynecology].

At present in gynecologic oncology no therapeutic strategy is possible without exact histopathological diagnostic procedures according clinical rationales. Describing morphological records, exact details are therefore necessary on clinical staging, histological grade and type of the tumor. This requires a standardized preparation technique and a clinically adapted microscopic working procedure on surgery material. Above all this is necessary for discrimination of defined early cancerous changes and invasive carcinomas.--Analysis of tumor metric is more and more completed by methods of picture analysis (tissue-texture). The principals of an optimal cooperation between clinicians and morphological workers in gynecologic oncology are presented as an example on common used macroscopic and microscopic preparation methods at the histological laboratory of the Department of Gynecologic Morphology at the University Hospital Heidelberg.

Biopsy↗

PubMed1982

DNA-flow-cytometric measurements on the normal, atrophic, hyperplastic and neoplastic human endometrium.

DNA distribution patterns and the fractions of the cell cycle phases were determined by means of flow-through cytometry in 87 samples of normal, atrophic, hyperplastic and carcinomatous human endometrium. The S-phase fractions vary during the normal menstrual cycle between 1 and 3% and reach a periovulatory maximum between 4.4 and 4.7%. Atrophic endometrium and regressive glandular cystic hyperplasia have little DNA synthesis (1.01% and 1.68% S-phase fractions respectively). Proliferating glandular cystic hyperplasia reveals 3.38% S-phase fraction, whereas adenomatous hyperplasia has an increased number of DNA-synthesizing cells (4.81%). The well-differentiated endometrial carcinoma shows no cytophotometrically detectable differences in comparison to adenomatous hyperplasia. All endometrial samples except for poorly differentiated endometrial carcinoma showed a diploid to tetraploid DNA distribution pattern. The poorly differentiated endometrial carcinoma displays two different types: one rapidly growing diploid-tetraploid tumor with 8.0 to 9.6% S-phase fractions, and another type with stemline deviations, polyploid nuclei and less pronounced synthetic activity.

Adenoma↗

PubMed1982

[The primary non-Hodgkin lymphoma of the mammary gland].

Basing on an observation made by the authors, the article describes the diagnostic and therapeutic criteria in primary non-Hodgkin lymphoma of the mamma. Despite high malignancy, especially of the lymphoblastic-centroblastic lymphoma and of the immunoblastic lymphoma (Stein, 1974), permanent healing can be achieved via early surgical treatment and subsequent radiotherapy. In the case under discussion, the same tumour reappeared in the contralateral breast after an interval of five years. Since it was possible to exclude a generalisation, it must be assumed that the patient in question had a primary non-Hodgkin lymphoma of the immunoblastic type in both mammae after a period of five years.

Breast Neoplasms↗

PubMed1982

[Diagnosis and treatment of uterine sarcoma].

A group of 54 patients with uterine sarcomata is reviewed. The diagnosis, the pathological anatomy, the treatment and the prognosis of this rare disease which only comprises between 2-4% of all malignant tumours of the uterus is described. Special attention is directed to the tumours of so-called low grade malignancy, regarding their clinical and prognostic aspects in relationship to their morphology and biological potency. The discussion of the treatment centered around the desirability of additional chemotherapy. The answers to the numerous questions in this group of tumours can only be obtained by prospective collaborative studies of randomized groups of patients.

Adult↗

PubMed1982

[Conditions of metastatic spread of endometrial cancer: analysis of autopsy findings and clinical data].

Among 263 patients who suffered from endometrial carcinoma and died of their disease or unrelated causes autopsies showed metastases or recurrences in 165 cases. The conditions for metastatic spread were analysed from the morphological parameters of the tumour. The incidence and localization of above all the lymph node metastases are closely correlated to the grading and the depth of invasion (I 0 to I 3/3) of the primary tumour. The incidence of pelvic lymph node metastases is 8.7% at an invasion depth I 1/3,33% at an invasion depth of I 3/3 of the myometrium. Tumours with the invasion depth I 1/3 show metastases in the para-aortic lymph nodes in 17.3% and at the invasion depth I 3/3 in 50% of the cases. At an invasion depth of I 3/3 17% had exclusively para-aortic lymph node metastases. Pelvic lymph node metastases were found in tumours of the grading G 1 in 5.7% of the cases, in grading G3 in 26% of the cases. The tumour grading and primary extent of the endometrial carcinoma area are closely correlated. At a grading G1 90% of the cases were in stage I/II and only 10% in stage III/or IV. At a grading G3 23.8% of the cases were stage I/II and 76.2% of the cases stage III/IV. Based on the presented analysis it is recommended to supplement the conventional treatment at an invasion depth I 2/3 of I 3/3 with radiotherapy of the para-aortic lymph nodes since 27.3 to 50% of these cases show para-aortic metastases. In 17% of the endometrial carcinomas with an invasion depth I 3/3 exclusively para-aortic lymph node metastases were found which do not respond to conventional treatment.

Adult↗

PubMed1982

[Morphology and clinical aspects of malignant mixed müllerian tumors of the corpus uteri].

Mixed muellerian tumours of the uterus are more common today than uterine leiomyosarcomata. There is a world wide increase in the incidence in the last few years. In the past 15 years we observed 20 mixed muellerian tumours of the uterine body. The patients are usually 10 years older than women with endometrial carcinoma or leiomyosarcoma of the uterus. Morphologically homologous and heterologous tumours must be differentiated. Characteristic is the marked polypoid growth. There is a close correlation between tumour stage and microscopic tumour grading. Tumours with high malignancy are usually in stage I or II. The prognosis correlates well with the grade and stage of the tumour, therefore the elaboration of a prognostic index is necessary. The survival rates are low. Mixed muellerian tumours are not at all or very little influenced by radiotherapy. The single or combined chemotherapies in use o date have not shown satisfactory success. As complete as possible surgical removal is therefore important. It cannot as yet be predicted whether our present combined treatment in stage III and stage IV by operation and post-operative combined chemotherapy with CYVADIC is liable to increase the survival rates.

Aged↗