Biomedical subjects
Publications and source records attributed to E Gitsch.
The evolution in the management of ovarian cancer at the First Department of Obstetrics and Gynecology of Vienna University is reviewed. The improvement in radical surgery and a more rational application of adjuvant treatment modalities produced a relative improvement in 5 year survival in the last period under review.
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Two sampling methods, biopsy and cell smear, were investigated for their reliability in the biotin in-situ hybridization test for human papilloma virus deoxyribonucleic acid (HPV-DNA)-6/11 and 16/18. Cervical smears and biopsies were obtained simultaneously from 81 women with cervical lesions. The sensitivity of the in-situ hybridization was tested on human cervical carcinoma cell lines. As a reference method, HPV-DNA was probed in biopsies using a Southern blot with 32P-labelled DNA probes. This reference method detected HPV-DNA in 45% of the reactive and reparative cell changes, in 75.9% of intraepithelial neoplasias, and in 83.3% of squamous cell carcinomas of the cervix. Of the examined cervices 61.7% were HPV-DNA-positive. As tested by in-situ hybridization, 56.8% of the biopsies were HPV-DNA-positive. Three biopsies were HPV-DNA-negative by the in-situ hybridization but positive by the Southern blot. One biopsy was HPV-DNA-6/11 positive by the in-situ hybridization but negative in the Southern blot. As tested by in-situ hybridization, 55.6% of the cervical smears were HPV-DNA-positive. Five smears were HPV-DNA-positive by the in-situ hybridization but negative by the reference method, thus demonstrating the dependence of the HPV positive rate on the sampling method. Four cell smears were negative by the in-situ hybridization but positive by the reference method, which shows that the biotin in-situ hybridization is less sensitive. The reference method confirmed the HPV-DNA-positivity of in-situ hybridization for 97.8% of biopsies, and for 91.8% of cell smears.(ABSTRACT TRUNCATED AT 250 WORDS)
Besides a relatively high frequency of perioperative and postoperative dysfunctions of micturition, urogenital fistulae are the most frequent complication occurring after surgical gynaecological interventions. Vesico-vaginal fistulae are the most common communication between the efferent urinary passages and the genital tract. From 1967 to 1987, 42 women who had developed a vesico-vaginal fistula after abdominal or vaginal surgery or irradiation were operated on again. Upon admission, all 42 patients were subjected to surgical closure of the vesico-vaginal fistula according to the vaginal method of Chassar Moir. In 41 women (97.6%) continence was re-established by adequate closure.
Aside from the more common perioperative and postoperative dysfunctions of micturition, urogenital fistulas represent the most frequent complication encountered after surgical gynecologic interventions. Vesicovaginal fistulas are the most common communication between efferent urinary passages and the genital tract. From 1967 to 1987, 42 women had a vesicovaginal fistula develop after abdominal or vaginal operations and underwent another operation. At admission, all 42 patients had surgical closure of the vesicovaginal fistula according to the vaginal method of Moir. In 41 women, continence was re-established by adequate closure.
A historical review is given on the installation of the Department of Radiotherapy of the 1st Department of Obstetrics and Gynecology and its further development to the Department of Irradiation of the 1st and 2nd Department of Obstetrics and Gynecology at the Vienna University. The milestones of the last 40 years like the change to the "New Stockholm Method" (1954), the new construction and adaptation (1968-1972) with the installation of a telecobalt-therapy-unit (1972), the conjunction of the department of radiotherapy of both university departments to a single department in the same year and finally the introduction of the after-loading method in brachytherapy (1980) are pointed out specifically.
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The relative advantages and disadvantages of the transabdominal versus the transvaginal approach to hysterectomy were evaluated and the two procedures were compared for differences in hospitalization, patient age, bowel activity and operating time on the basis of a material of 94 hysterectomized patients. Intestinal complications such as subileus were noted only in subjects who were treated by abdominal hysterectomy. This corresponded with the significant decrease in potassium in abdominally operated patients on the second post-surgical day. Transvaginal hysterectomy was found to be superior in terms of all of these parameters. Complications associated with the two procedures were also compared. Of eight potential complications, seven were found to be confined to laparotomy, while only one occurred after transvaginal hysterectomy which was, however, invariably combined with colporrhaphy. The conclusion from the above should, therefore, be not to select patients indiscriminately for either the transvaginal or the transabdominal approach, but rather to use both routes of access as best fits the circumstances.
Besides the relatively frequent perioperative and postoperative dysfunctions of micturition, urogenital fistulae are the most frequent complication occurring after surgical gynaecologic interventions. Vesico-vaginal fistulae are the most common communication between efferent urinary passages and genital tract. From 1969 to 1986, 36 women developed a vesico-vaginal fistula after abdominal or vaginal surgery and were operated on again. Upon admission, all 36 patients were subject to surgical closure of the vesico-vaginal fistula according to the vaginal method of Chassar Moir. In 35 women (97.2%) continence was re-established by adequate closure.
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The Authors report their experience with intraperitoneal chemotherapy in post surgical management of ovarian cancer. 24 patients were evaluable for the study and the results indicate that in patients with bulky disease the complication rate was high and the therapeutical outcome very poor. Only in patients with microscopic disease and residual tumor smaller than 2 cm seemed to benefit from intraperitoneal chemotherapy. Despite pharmacological advantages, Mitoxantrone causes local discomfort up to peritonitis.
The diagnostic possibilities of immunoscintigraphy (IS) in ovarian cancer are discussed. Seventy-five patients were investigated by IS using the radioantibodies HMFG-2 (n = 63) or OC-125 (n = 12). The results showed a specificity of 75%, sensitivity of 87%, and accuracy of 84%. An intraoperatively usable gamma ray detection probe was developed in order to achieve better results than with conventional IS. Twelve patients were investigated using this probe. A future clinical value was indicated for intraoperative detection of lymphnode metastases and/or small tumor deposits.
A new strategy for tumor detection using immunoscintigraphic techniques was used in an attempt to improve the diagnostic potential of conventional external immunoscintigraphy. Twelve patients who were strongly suspected to either suffer from primary or recurrent ovarian cancer were investigated as follows: radioimmuno-scintigraphy (RIS) by means of radiolabelled antibodies was performed in all patients prior to operation (first or second look). During the operative procedure, which always took place immediately after completion of the diagnostic RIS, a hand-held gamma-ray detection probe, especially developed for this purpose was used for the purpose of identifying radiolabelled tumor sites intra-operatively in the open abdomen. In 10 out of 12 of the investigated patients, Radioisotope-Assisted Surgery (RAS) could be performed successfully. The count rates in cancer sites ranged from 150-250 cts per 6 s vs. 30-50 cts per 6 s in normal tissues. While the presence of malignant-tumor sites could always be predicted by conventional RIS, RAS failed twice, but revealed more accurate information concerning the real extent of the disease.
A hand-held gamma-ray detection probe was developed by us to circumvent the problems of conventional radio-immunoscintigraphy (RIS). The intraoperative use of this probe in terms of radionuclide-assisted surgery (RAS) should help to overcome problems associated with insufficient accumulation by the tumour of the radio-active antibodies, unfavourable localization of tumour sites, collimation problems, etc., in patients with ovarian cancer. The probe was designed as a scintillation counter. Twelve patients were operated upon and investigated by RAS. It could be shown that RAS is able to detect tumour tissue intraoperatively, although we have already seen that improvements in the probe are necessary to make the method of real clinical value.
During the period 1970-1981 radioisotope radical surgery was performed in 270 patients suffering from cervical carcinoma stage Ib und II. During the development of the method, which has a three-stage process, the rate of cases with complete lymphadenectomy was increased from 52.5% to 75.8%. The 5-year recurrence mortality rate decreased in stage Ib patients during this period from 15.8% to 8.4%.
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After a historical outlook on the development of radical vaginal hysterectomy, our own results and complications in 51 cases of stages I and II during the years 1968-1983 are reported. The 5-year survival rate was 98.04% with no primary mortality.
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