A case of HELLP syndrome at 23 weeks' gestation.
We report a case of the HELLP syndrome at 23 weeks' gestation. Prolongation of pregnancy until the fetus was viable was not possible.
Adult↗
Biomedical subjects
G Crombach
Publications and source records attributed to G Crombach.
[The prognostic significance of cathepsin D in primary breast cancer].
The prognostic significance of the lysosomal protease cathepsin D in breast cancer was evaluated in a retrospective study. Cathepsin D was measured in 346 deep-frozen (-70 degrees C) cytosol specimens of primary breast carcinomas (1982-1990). Among the established prognostic factors, only axillary lymph node involvement correlated with the expression of cathepsin D (> 40/60 pmol/mg) (p = 0.04-0.05). Univariate analyses of disease-free survival (DFS) and overall survival (OS) showed, that the expression of cathepsin D had no effect on the prognosis either in the whole population of breast cancer patients during long-term follow-up (n = 302; median observation time 51 months) or in the group of women with positive lymph nodes (n = 157; 46 months). However, within the group of N0 patients (n = 145; 57 months), high cathepsin D levels were associated with an unfavourable OS, but this relationship was statistically insignificant (p = 0.08-0.13). A similar influence of cathepsin D on DFS could not be demonstrated. Compared to tumour size, grading and receptor status in multivariate analysis, cathepsin D was a more indicative, but finally insignificant prognostic factor for OS. According to these results, cathepsin D may contribute only in combination with other prognostic factors to identify those 20-30% of node-negative patients with unfavourable prognosis, who may benefit from adjuvant therapy.
Adult↗
Two fetuses with Fryns syndrome without diaphragmatic defects.
We report two fetuses with Fryns syndrome including the typical facial appearance and distal limb and lung hypoplasia, but no diaphragmatic hernias. The parents were consanguineous. Characteristic in both cases were the distal limb defects with brachytelephalangism and aplasia of the distal phalanges of the first toe. Since one of the two sibs had severe lung hypoplasia without macroscopic or microscopic defects of the diaphragm, we show that lung hypoplasia can occur independently from diaphragmatic defects in Fryns syndrome.
Abnormalities, Multiple↗
Expression of pS2 protein in breast cancer.
The pS2 protein was first detected in the oestrogen-dependent breast cancer cell line MCF-7. It may have prognostic value for primary breast cancer, and could be used to predict clinical responsiveness to endocrine therapy. In a retrospective study, the concentrations of pS2 protein were determined in 434 cytosol specimens using an immunoradiometric assay. The median values (4, 6 and 3 ng/mg protein) and the third quartiles (27, 26 and 29 ng/mg) in benign breast tumours (n = 17), and in primary (n = 325) and recurrent (n = 37) breast carcinomas were of the same order of magnitude. In primary breast cancer, high pS2 values (> 26 ng/mg) correlated significantly with a positive oestrogen receptor (ER) status and a high grade of tumour differentiation (P = 0.01). As many as 85% of the pS2 positive tumours were ER positive. A marginally significant correlation (P = 0.06) was also found between pS2 status and the quantitative expression of the ER. However, the pS2 values in ER positive endometrial carcinomas (n = 12) as well as in other benign and malignant genital tumours (n = 43) were more than 30 times lower than those measured in breast tumours. The results reveal a close association between pS2 protein and ER status which appears to be limited to breast cancer.
Biopsy↗
[Follow-up of tumor markers in evaluating the effectiveness of chemo- or hormone therapy in metastatic breast cancer].
We compared the course of the tumour markers CEA and CA 15-3 with the clinical course of 62 patients with metastasising breast cancer. The patients were treated by an aggressive chemotherapy (FAC-regimen) or high-dose hormonal therapy (1000 mg MPA/day). The markers were determined after a well-defined schema. In patients treated with aggressive chemotherapy, the markers were determined 4, 8 and 12 hours as well as 7 days after each course. In patients treated with hormonal therapy, the markers were determined weekly from the first to 12th week as well as 4, 8 and 12th week after onset of therapy. The course of the tumour markers was compared with the results of the radiological and clinical staging three months after beginning of therapy. For patients treated with aggressive chemotherapy CEA withdrawn 4 hours after the first and second cycle resulted in medium predictive values of 88% for marker increase and 93% for marker decrease. In comparison, the predictive values of CA 15-3 were 81% for marker increase and 71% for marker decrease. Both markers obtained better results when withdrawn four hours after therapy compared to values withdrawn 7 days after therapy. In high-dose hormonal therapy, the determination of markers collected four weeks after onset of therapy is sufficient for predicting the clinical course. The medium predictive values of CEA after 4 and 8 weeks amount to 83% for marker increase and 87% for marker decrease. In comparison, the predictive values of CA 15-3 are 95% vs. 85%.(ABSTRACT TRUNCATED AT 250 WORDS)
Antigens, Tumor-Associated, Carbohydrate↗
[Prolongation of a primary twin pregnancy to the 31st week of pregnancy by surgical extraction of the 1st twin in the 17th week of pregnancy for umbilical cord prolapse].
A 24-year-old woman with a twin pregnancy had a premature rupture of membranes (PROM) of the first foetus in the 16th gestational week (gw). After 9 days the umbilical cord prolapsed. In the 17th gw the foetus was extracted by vaginal hysterotomy, because of an inferior anterior wall placenta. The patient remained hospitalised receiving tocolysis, lung maturation induction and prophylactic antibiosis. The pregnancy could be prolonged for 109 days after PROM and 99 days after the extraction of the first twin. The second child was born in the 31st gw by Caesarean section, following uncontrollable labour.
Adult↗
Insulin use in pregnancy. Clinical pharmacokinetic considerations.
Explore the source record for details and available documents.
Female↗
[Cathepsin D expression in primary breast cancer. Comparison of immunohistochemical and biochemical results].
Cathepsin D expression was immunohistochemically tested in 126 formalin-fixed and paraffin-embedded tissues from primary breast cancers. Specific staining was noted in the cytoplasm of tumor cells in 43% of tumors. In 44% of cases cathepsin D was detected in tumor stroma. A total of 63% of the tissue samples stained positive for cathepsin D (tumor and/or stromal staining). In all cases the cathepsin D level was measured in tumor cytosol by radioimmunoassay. Cytosols were considered positive when cathepsin D concentrations of over 40 pmol/mg cell protein were found. Comparison of immunohistochemical and biochemical detection of cathepsin D revealed a 76% concordance rate. Univariate analysis showed a significant correlation of cathepsin D expression with axillary node involvement; no correlation was found with tumor size, tumor grade, steroid receptor status or age of patients. Our results demonstrate a close agreement between the results of biochemical and of immunohistochemical cathepsin D detection.
Adult↗
[Results of transabdominal placental biopsy in the 2nd and 3d trimester].
From August 1988 to October 1990, 115 transabdominal placental biopsies were performed in the second (68%) and third trimenon (32%). The main indication (80%) was the detection of pathological ultrasonographic findings (foetal malformation, growth retardation, oligohydramnios and polyhydramnios). The success rate of chorionic villus sampling (89%) was independent of the localisation of the placenta. A definite cytogenetic result was found in 83% of patients. By combination of placental biopsy and amniocentesis (n = 77) karyotyping was successful in 97% of pregnancies. Chromosomal abnormalities were observed in 15 (13%) cases (7 autosomal and 2 gonosomal aneuploidies, 1 unbalanced translocation, 1 autosomal deletion, 4 structural variants). The outcome of the pregnancies was substantially influenced by the indication for the procedure and by the cytogenetic result. Foetal and peri-/neonatal losses were found in 53% (3% spontaneous abortions) of patients with sonographic abnormalities (n = 92) and in 9% (abortion rate 4%) of pregnancies with regular findings (n = 23). The pregnancy loss rates were 37.7% and 5.9%, respectively. The results confirm the clinical significance of placental biopsy in the management of pregnancies with pathological ultrasonographic findings.
Chorionic Villi↗
Antigen CA 19-9: presence in mucosa of nondiseased müllerian duct derivatives and marker for differentiation in their carcinomas.
CA 19-9, a side branch of the Lewis blood group system, is a sialylated Lewis A antigen that is highly expressed by many adenocarcinomas of the digestive tract. The müllerian duct-derived mucosa of the uterus and fallopian tubes also synthesizes Lewis blood group antigens. To test whether the expression of CA 19-9 is enhanced in carcinomas of müllerian duct origin, we performed immunohistochemical staining for CA 19-9 in normal tissues from 33 women and in adenocarcinomas from 88 patients. In the normal uterine cervix, CA 19-9 was expressed in the cytoplasm of scattered glandular cells in 26 of 29 specimens. It was observed in the apical regions of mucosal cells in six of 26 normal endometrial samples and two of 13 normal fallopian tube specimens. These results are consistent with the presence of antigen CA 19-9 on a secretory product of the nondiseased mucosa of the müllerian duct. In adenocarcinomas of the endocervix, endometrium, and fallopian tubes, CA 19-9 was found in seven of 11, 57 of 71, and five of six samples, respectively. Progressive loss of differentiation was accompanied by disruption of subcellular localization of CA 19-9 and its secretion toward the glandular lumina. In well-differentiated regions of tumors, the antigen was detected mainly at the luminal surface of cancerous glands, whereas the staining was mostly cytoplasmic or vacuolar in less differentiated areas. The degree of CA 19-9 expression was inversely related to tumor differentiation (P less than .001).
Antigens, Tumor-Associated, Carbohydrate↗
[Pregnancy outcome with intensified insulin therapy in manifest diabetes].
In 1981, the intensified insulin therapy for achievement of euglycaemia in pregnant diabetics was introduced at the University Department of Obstetrics and Gynaecology in Cologne. This study compares the results of 112 pregnancies in women with overt diabetes monitored before (1971-1980) or after (1981-1988) changing the therapeutic regimen. In the period from 1981 to 1988, the proportion of euglycaemic patients (preconceptionally 19%, before delivery 79%) was clearly higher than from 1971 to 1980 (n = 42; 7% and 9%, respectively). The tight blood glucose control resulted in a doubling of hypoglycaemic episodes during pregnancy. The proportion of preterm deliveries was reduced from 47% to 24%. The rate of caesarean sections was nearly constant (1971-1980: 38%, 1981-1988: 34%). The marked success of therapy was the decrease of perinatal mortality from 20.9% to 2.9%. The perinatal morbidity also diminished, as shown by the decreasing rates (30-90%) of foetopathy, macrosomy, respiratory distress syndrome, birth trauma, hypoglycaemia, hypocalcaemia and polycythaemia. The malformation rate, however, remained high (1971-1980 = 7%, 1981-1988 = 11%). The results demonstrate the necessity of a strict blood glucose control during pregnancy, beginning before the time of conception.
Adult↗
[The importance of the SCC antigen in the diagnosis and follow-up of cervix carcinoma. A cooperative study of the Gynecologic Tumor Marker Group (GTMG)].
SCC (squamous cell carcinoma) antigen is a subfraction of tumour antigen TA-4 isolated from cervical squamous cell carcinomas. Serum concentrations of SCC antigen were measured by radioimmunoassay in 382 control subjects, 70 women with cervical intraepithelial neoplasia (CIN), 517 with cervical carcinoma and 203 with other gynaecological carcinomas. Elevated SCC antigen levels (greater than 2.5 ng/ml) were found in 4% of normal controls, in 7% of women with CIN I-III, in 2%-23% with various forms of genital adenocarcinomas, in 55% with primary and in 76% of those with recurrent cervical squamous cell carcinoma. The positivity rate of the antigen was correlated with tumour stage (FIGO) and lymph node involvement of primary cervical squamous cell carcinomas. During long-term follow-up serum levels of SCC antigen were found to be concordant with tumour activity in 74% of cases. Patients with still elevated marker levels after therapy had twice the recurrence rate of women with normal serum values. Routine determination of SCC antigen during follow-up of cervical cancer is recommended.
Antigens, Neoplasm↗
Detection of squamous cell carcinoma antigen in normal squamous epithelia and in squamous cell carcinomas of the uterine cervix.
Squamous cell carcinoma (SCC) antigen is a subfraction of tumor antigen TA-4 isolated from a cervical squamous cell carcinoma. The specificity of SCC antigen and the factors influencing its release into serum were evaluated. Antigen concentrations were measured in 157 tissue extracts and in 188 sera of patients with nonmalignant or malignant gynecologic diseases. A commercial radioimmunoassay based on polyclonal antibodies (Abbott Laboratories, North Chicago) was used. Cytosol concentrations were significantly higher (P less than 0.005) in normal squamous epithelia (means = 6040 ng/mg cell protein [CP]) and in squamous cell carcinomas (means = 2483 ng/mg CP) of the exocervix than those in normal columnar epithelia and in adenocarcinomas of the endocervix, endometrium, ovary, and breast (means = 1-508 ng/mg CP). Despite the high antigen concentrations in normal squamous epithelia, elevated serum levels (greater than 2.5 ng/ml) were almost exclusively found in patients with cervical squamous cell carcinomas. The sensitivity of SCC antigen as a marker for primary carcinomas was 61%, increasing from 29% in Stage I to 89% in Stage IV. The positivity rate was higher in women with well-differentiated (78%) and moderately differentiated carcinomas (67%) than in those with poorly differentiated tumors (38%). The results show that SCC antigen is not tumor specific. The release into serum is independent of local tissue content, but is apparently influenced by the infiltrative growth, the mass, and the degree of histologic differentiation of the tumor.
Adenocarcinoma↗
CA 125 in normal tissues and carcinomas of the uterine cervix, endometrium and fallopian tube. I. Immunohistochemical detection.
The distribution of cancer antigen 125 (CA 125) has been investigated in normal tissues and carcinomas of the Müllerian duct by immunohistochemical methods using the monoclonal antibody OC 125. Detection of CA 125 was most intense in cryostat sections and decreased in formalin fixed and paraffin embedded tissues according to the duration of fixation. Enzymatic digestion with neuraminidase or alkaline hydrolysis abolished specific staining suggesting the antigen is a sialylsaccharide bound to protein by alkali-labile linkage. Immunohistochemical staining demonstrated the presence of CA 125 in all normal glandular epithelia of the endocervix, endometrium and fallopian tube in different distribution patterns. In normal endometrium the cellular distribution pattern was related to the menstrual cycle. In endocervical, endometrial and tubal adenocarcinomas CA 125 was found in 73% of cases. In glandular structures the antigen was concentrated at the luminal surface of the tumour cells, in solid tumour areas it was spread throughout the cytoplasm or concentrated in large cytoplasmic vacuoles. The expression of CA 125 was considerably lower in solid tumour areas. These data show that CA 125 is not a true "tumour marker", but a product of female genital mucosae and of their cancerous derivates provided their synthesizing ability is not lost in the course of pathologic differentiation.
Antigens, Tumor-Associated, Carbohydrate↗
CA 125 in normal tissues and carcinomas of the uterine cervix, endometrium and Fallopian tube. II. Immunoradiometric determination in secretions, tissue extracts and serum.
The study deals with the occurrence of cancer antigen 125 (CA 125) in the normal and neoplastic uterine cervix, endometrium and fallopian tube and its applicability as a tumour marker. CA 125 concentrations were measured in 52 secretion specimens, in cytosol fractions of 97 tissue biopsies and in serum from 47 women with nonmalignant disorders and from 334 patients with carcinomas. High quantities of CA 125 (780-454860 U/ml) were detected in cervical mucus, intra-uterine and tubal fluid, exceeding those in the corresponding serum samples by factors of up to 2000. CA 125 concentrations were 9-53 fold higher in cytosol fractions of normal and neoplastic glandular epithelia of the endocervix and endometrium than in those of cervical squamous epithelia and the cervical wall. Despite similarly high antigen concentrations in normal glandular epithelia and adenocarcinomas serum levels elevated to above 65 U/ml were only found in patients with malignant tumours. The positivity rates in serum increased with tumour extent and were 0-43% for primary and 63-79% for recurrent cervical, endometrial and tubal adenocarcinomas. During long-term follow-up, CA 125 serum concentrations were concordant with the clinical course in 10 out of 11 patients with progressive carcinomas. According to these results, the release of CA 125 into the peripheral blood is apparently dependent on the infiltrative growth and the mass of the tumour rather than on the local tissue concentrations. The clinical use of CA 125 is limited to the detection of advanced adenocarcinomas of the Müllerian duct.
Adenocarcinoma↗
[Pregnancy during cyclosporin medication following a kidney transplant].
A 33-year-old patient became pregnant two years after transplantation of a cadaver kidney and continuous cyclosporine administration. An uncomplicated spontaneous delivery of a healthy boy weighing 3360 g took place in the 40th week. Cyclosporine was demonstrated in umbilical cord and neonatal blood and in the mother's milk, but not in amniotic fluid. Because mother's milk contained one sixth the concentration of cyclosporine in maternal blood, the mother was dissuaded from breast feeding.
Adult↗
[Symptom of "urinary incontinence" as an indication of tubal cancer].
Discontinuous vaginal discharge in two patients, caused by a carcinoma of the fallopian tube, was misinterpreted as urinary incontinence for months. Complexes of atypical glandular epithelia in the cervico-vaginal smears and detection of adnexal tumors indicated the correct diagnosis.
Adenocarcinoma↗
Radioimmunoassay of laminin P1 in body fluids of pregnant women, patients with gynaecological cancer and controls.
Laminin P1, a pepsin-resistant fragment of the glycoprotein laminin, was determined in body fluids using a double-antibody radioimmunoassay. The median serum concentrations found were: men 1.32, premenopausal women 1.22, postmenopausal women 1.38 and pregnant women (35th gestational week) 2.18 U/ml. The median concentration in amniotic fluid was 1.90, in urine 0.28 and in follicle cyst fluid 1.74 U/ml. During gestation, rising serum levels of up to 5 U/ml were observed which decreased within a few days after delivery. The cut-off value of laminin P1 for 95% specificity of the normal female control group was found to be 1.8 U/ml. The frequencies of elevated serum concentrations were 11, 18, 23 and 33% in patients with primary malignant lesions of the breast, endometrium, cervix and ovary, respectively, and rose up to 50-51% in patients with recurrent or metastatic gynaecological cancer. Laminin P1 was found in high concentrations in the cytosol fractions of breast cancer biopsies. Long-term sequential determinations of serum levels in 10 individual patients with progressive cancer reflected the course of the disease in 8 cases. Although laminin P1 can be considered as a tumour-associated protein, low sensitivity to primary cancer and insufficient specificity limit its application as a tumour marker and its usefulness in monitoring of patients with gynaecological cancer.
Body Fluids↗