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Biomedical subjects

E Joura

Publications and source records attributed to E Joura.

16 recordsLinked to original sources
PubMed1997

Successful treatment of a high-risk choriocarcinoma in Figo stage IV (WHO score 12).

In the present report, a case of high-risk choriocarcinoma (Figo stage IV, WHO score 12) with persisting vaginal and urethral bleedings is described. In addition to a course of multiagent chemotherapy, arterial embolization of both iliac vessels using Gianturco coils was carried out. This caused a dramatic improvement of the patient's general condition. A subsequently performed laparatomy with extirpation of the uterus and both adnexa finally led to remission.

Adult↗
PubMed1995

Differential diagnosis of detrusor instability and stress-incontinence by patient history: the Gaudenz-Incontinence-Questionnaire revisited.

OBJECTIVE: To evaluate the validity of the Gaudenz-Incontinence-Questionnaire in the differential diagnosis of genuine stress-incontinence and detrusor instability. DESIGN: Diagnoses based on questionnaire-results were compared to those following complete urogynecologic assessment including urodynamics in 1938 patients with lower urinary tract symptoms. RESULTS: Sensitivity and specificity for diagnosis of stress-incontinence were 0.559 and 0.447, respectively, for detrusor instability 0.615 and 0.563, respectively. CONCLUSION: The low sensitivity and specificity of the test do not justify its use as a diagnostic tool in patients with urinary incontinence. These results show that the scores may be misleading in a large proportion of patients and should not therefore be the only determinant of diagnosis, nor should strategies be based on history alone.

Adult↗
PubMed1994

[Hyperreactio luteinalis in pregnancy].

We report on the extremely rare case of ovarian overstimulation in a single pregnancy without prior hormonal stimulation therapy. During the 26th week of gestation ultrasound examination showed a 103 x 57 x 78 mm polycystic tumour with echogenic structures inside the cysts, located behind the uterus. Further management consisted of laparotomy with partial resection of a cystic part of the left ovary. Frozen section examination confirmed the diagnosis of hyperreactio luteinalis and excluded malignancy. To avoid torsion of the ovaries, cysts from both sides were aspirated. On day 8 and 18 after surgery, sonography revealed no pathological finding. In the 40th week of gestation, a healthy baby was delivered. The possibility of a hyperreactio luteinalis has to be kept in mind, when cystic solid tumours of the ovaries are diagnosed during pregnancy. A conservative management is appropriate, because a normal spontaneous remission occurs after delivery.

Adult↗
PubMed1994

[Is the Gaudenz Incontinence Questionnaire still relevant in diagnosis of urodynamic function?].

The results of this study show that the Gaudenz incontinence questionnaire can still be used to help determine the history of the incontinent patient. However, the questionnaire cannot substitute--Gaudenz stressed this fact in his study--a complete urogynecologic workup. Especially delicate problems as urinary incontinence require reliable and objective diagnostics and therapy using the advantages of the available diagnostic potential.

Female↗
PubMed1994

[Radiosurgical treatment of cervical intraepithelial neoplasia].

In the present study we present our experience and data with loop electrosurgical excision procedures for the treatment of human papilloma virus (HPV)-associated lesions and intraepithelial neoplasia of the cervix. 58 patients underwent loop excision because of colposcopically suspect cervical lesions. In 78 cases cone biopsy (large loop excision of the transformation zone, LLETZ + partial resection of the cervical canal) was performed. In 80% of the loop excisions the lesions were removed with clear resection margins. Patients undergoing LLETZ conization were compared to patients who had a cold knife conization previously. The two groups were matched with regard to age, parity and histology. The cone specimen of patients with LLETZ conization revealed lesion-free margins in 93% compared to 87% in the group with cold knife conization. Operation time and duration of hospital stay were significantly shorter in the group of LLETZ conization. Loop electrosurgical excision procedures therefore represent an adequate method for the treatment of HPV-associated lesions and intraepithelial neoplasia of the cervix.

Biopsy↗
PubMed1992

[Primary Figo stage III melanoma of the uterine cervix].

Malignant melanoma of the uterine cervix is a rare neoplasm with poor prognosis. Diagnosis is confirmed by immunohistochemical methods and by exclusion of other primaries. The common treatment is radical surgery. In advanced stages, primary irradiation can be successful. We report on a case of an 83 years old patient, suffering from a malignant melanoma of the uterine cervix FIGO III AB, diagnosed by histological and immunohistochemical methods. Due to combined irradiation, complete remission of the tumour was achieved. Nevertheless, the patient died of the malignancy 15 months later.

Aged↗
PubMed1992

[The value of intraoperative rapid biopsy study in diagnosis of breast cancer].

432 biopsies of mammary tumours performed between 1988 and 1990 were reviewed to evaluate the accuracy of rapid frozen section diagnosis. 15 (3.47%) had to be deferred to await subsequent permanent paraffin section. There were 4 (2.55%) false negative diagnoses. These cases consisted of small, nonpalpable and in-situ lesions. No false positive diagnosis was noted during the observation period. Sensitivity of frozen section histology was 97.45%, specificity 100% and efficiency 96.53%. Rapid frozen section diagnosis is a highly accurate and reliable tool which helps to avoid a consecutive operation in patients with breast cancer.

Adult↗
PubMedDate not supplied

Mutant p53 product in patients with stage III cervical cancer.

Mutations in the p53 gene stimulate cell division. In our study we assessed the prognostic value of mutant p53 overexpression in cervical cancer stage FIGO III detected by immunohistochemistry. In 43 tissue specimens were detected p53 overexpression in 20 cases. Mean survival time was 36.4 (SE +/- 7.66) months in the p53 protein positive group. The group without p53 overexpression showed a mean survival time of 28.6 (SE +/- 3.85) months. p53 protein overexpression had no prognostic value in patients with stage III cervical cancer.

Female↗
PubMedDate not supplied

Squamous cell carcinoma antigen, tumor associated trypsin inhibitor and tissue polypeptide specific antigen in follow up of stage III cervical cancer.

189 clinical and serological examinations were performed in 30 patients before treatment and during follow up of squamous cell cervical cancer stage FIGO III. The serum levels of the tumor markers squamous cell carcinoma antigen (SCC), tumor associated trypsin inhibitor (TATI) and tissue polypeptide specific antigen (TPS) were determined. Sensitivity/specificity for SCC was 63%/91%, TATI 54%/74%, TPS 59%/86% and for a combination of SCC and TPS 81%/77%. In 14 women with recurrence of disease SCC showed lead time effects in seven patients in a time range from three to nine months. SCC was pre-therapeutically elevated in nine cases and showed lead time in five of them. Pretherapeutic TPS serum levels were elevated in seven cases. In all of them lead time effects appeared ranging from three to nine months. TPS never showed lead time effects in patients without elevated pretherapeutic levels. A combination of SCC and TPS in our material provided lead time in 10 of 14 cases.

Adult↗
PubMedDate not supplied

[Effectiveness and tolerance of tramadol with or without an antiemetic and pethidine in obstetric analgesia].

The aim of this prospective, randomised, blind study was to investigate the analgesic potency and tolerance of intramuscular Tramadol compared to a standard obstetric analgesia with Pethidine. Triflupromazine was administrated in combination with the two tested analgesics in order to study its efficacy in alleviating the emetic side effects of the tested analgesics. 66 parturients were randomly assigned to three groups: group A: 100 mg Tramadol (Tramal), group B: 100 mg Tramadol (Tramal) and 10 mg Triflupromazine (Psyquil), group C: 50 mg Pethidine (Alodan) and 10 mg Triflupromazine (Psyquil). No significant differences concerning duration of labour, FHR-alterations, umbilical cord blood gases, respiration pattern and Apgar Scores of the neonate occurred. In all three groups the analgesic effect was equally good. Combination of the analgesic with the antiemetic showed no reduction of the incidence and severity of side effects.

Adult↗
PubMedDate not supplied

[Obstetric management of patients with HELLP syndrome].

The syndrome of haemolysis, elevated liver enzymes and low platelet count (HELLP-Syndrome) is a severe form of preeclampsia and eclampsia. The clinical course is characterized by right upper quadrant and epigastric pain, hypertension, proteinuria and edema. Maternal and neonatal morbidity are high. The underlying cause for this pregnancy-related syndrome is still unclear. As soon as a reliable diagnosis is established handling of patients suffering from HELLP-Syndrome is ambivalent: Immediate termination of pregnancy, however, poses a problem at early gestational age. Therefore some authors have advocated a conservative management. At our department active management and delivery by Caesarean section as soon as possible has gained acceptance in the past 5 years. We report our experience with 23 patients over a 12 year period, and with 4 patients from the intensive care unit (N = 27). Mean gestational age was 33.5 weeks (+/- 4.8) and the mean birthweight was 1922.5 g (+/- 971.5). 19 patients were delivered by Caesarean section. Most complications were based on a delayed delivery and subsequent deterioration of maternal condition. Reduction of the time interval between establishment of diagnosis and termination of pregnancy (1980-1985-3 days; 1986-1992-12 hours) resulted in a better outcome. We recommend intensive laboratory screening and exact clinical examination since missed or delayed diagnosis as well as delayed delivery are life threatening for mother and child. Only prompt delivery yields an improvement of prognosis.

Adult↗