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Biomedical subjects

H Hepp

Publications and source records attributed to H Hepp.

At least 37 records · Page 2Linked to original sources
PubMed1994

Flow cytometric DNA analysis of breast cancer by two colour method using cytokeratin labeling for identification of tumour cells.

Flow cytometric assessment of DNA-ploidy and S-phase fraction in breast cancer is compromised by the heterogeneity of cell subpopulations derived from the malignant and surrounding connective tissue, e.g. tumour, stromal and inflammatory cells. To identify tumour cell subpopulations, epithelial cells were labeled by a FITC-conjugated cytokeratin antibody (CK6, CK18) prior to flow cytometric cell cycle analysis in 205 fresh specimens of primary breast cancer. We found 158/205 (77%) DNA-aneuploid tumours compared to 127/205 (62%) without identification of cytokeratin positive cells (P < 0.001). In addition, the number of detected DNA-multiploid tumours rose from 31 (15%) to 51 (25%) after gating for cytokeratin positive cells. In DNA-diploid tumours, S-phase and G2M-phase fractions were significantly higher in cytokeratin positive (tumour) cells compared to total cell populations (4.4% and 5.8% vs. 3.2% and 4.4%; P < 0.001). Cytokeratin negative cells were found in all tumours and can be used as internal standard for calculation of ploidy and for quality control (CV, linearity) of each individual sample. We conclude that at least 20% of DNA-aneuploid tumours would not have been diagnosed without cytokeratin labeling. In addition, influence of non-tumourous cell elements on cell cycle analysis can be markedly reduced. Therefore, both determination of DNA-ploidy and cell cycle analysis can be optimized by cytokeratin labeling.

Breast Neoplasms↗
PubMed1994

[Requirements in preoperative diagnosis of gynecologic diseases of the pelvis].

Correct diagnosis of disease, staging of malignancies and detection of primary or secondary abnormalities of the adjacent pelvic organs are the basic requirements of preoperative diagnostic procedures in gynecological disorders. The latter is usually done by ultrasound, intravenous pyelography and endoscopic examination of the bladder and the colon. The diagnosis of disease with respect to malignancies of the uterus, vagina and vulva can usually be made by clinical examination and histology obtained by biopsy. On the other hand, ovarian tumors cannot be sufficiently differentiated by clinical methods. Ultrasound, magnetic resonance imaging and computed tomography may be helpful, but definitive diagnosis usually requires a surgical approach. This is also true for staging of gynecological malignancies. Nevertheless, improvements in preoperative diagnostic procedures allow individualized planning of surgery and improved staging in patients treated primarily by radiotherapy.

Diagnosis, Differential↗
PubMed1994

Low-dose follicle stimulating hormone for ovulation induction in polycystic ovary syndrome.

In 20 patients with clinically, sonographically and endocrinologically proven polycystic ovary syndrome, ovulation induction with low doses of follicle stimulating hormone (FSH) was attempted by administration for 27 menstrual cycles. One ampule FSH was administered from day 3 onwards. If the ovarian response was inadequate after days 10-12, the daily FSH dose was increased by half an ampule until ovulation induction. Of the cycles, 55.5% were monofollicular, whereas 4 cycles had to be cancelled due to a multifollicular response or failure of ovarian stimulation. On average, 14.4 ampules was used, and human chorionic gonadotropin was given on day 16. Seven pregnancies were established, with all of them ongoing at this writing. One twin pregnancy and one triplet pregnancy occurred. Even in polycystic ovary syndrome patients, low-dose administration of FSH allows safe stimulation, with a low incidence of ovarian hyperstimulation, a high pregnancy rate and an acceptably low risk of multiple pregnancies.

Adult↗
PubMed1994

A profile of geriatric trauma in southeastern Wisconsin.

The purpose of this study was to profile geriatric trauma in southeastern Wisconsin, including injury mechanisms, severity of injury, outcome, hospital lengths of stay, and total cost. We conducted a retrospective chart review of trauma victims over age 65 admitted to the Milwaukee County Medical Complex between July 1991 and October 1992. Cases were excluded if the patients had sustained isolated head or orthopedic injuries, thermal burns, or penetrating trauma. A total of 65 cases were studied. The population had a mean age of 75.8 +/- 8.2 years; 53.8% were women and 46.2% were men. The leading mechanisms of injury were in decreasing order were motor vehicle crashes, falls, and auto-pedestrian injuries. The mortality rate was 29.2%. The mean length of stay in the hospital was 13.5 days. The total charge was approximately $1.3 million dollars. Motor vehicle crashes accounted for 61.5% of injuries. Safety devices and driver awareness programs may be under used in this population. The mortality rate is high with a moderate level of injury severity.

Accidental Falls↗
PubMed1993

[Adenocarcinoma and adenosis of the vagina. On the histogenesis, diagnosis and therapy of a rare genital neoplasms].

In the United States, vaginal adenosis and clear-cell carcinoma of the vagina were frequently observed in young women, who had been exposed to the synthetic estrogen diethyl-stilbestrol (DES) during their embryonic development. In Germany, obviously, no such exposure occurred. Clearly, such diseases also develop without the context of intrauterine exposure to certain substances. Our own case of such a partly exophytic, partly endophytic adeno-carcinoma of the vagina with multifocal vaginal adenosis, demonstrates the histogenesis, symptoms, diagnostic procedures and therapy of this rare disease. Since young women during their reproductive years are mostly affected, the possibility of fertility-conserving surgery is discussed despite the current practice of radical cancer surgery (with and without radiation). In the 25-year-old patient, we conducted a colpectomy whilst leaving the uterus and ovaries, and replaced the vaginal defect by a sigmoid transplant anastomosed to the cervix. The patient has regular menstrual cycles, should, however, not become pregnant for 1 to 2 years for oncological reasons.

Adenocarcinoma↗
PubMed1993

[The value of reoperation in the treatment of ovarian cancer].

Recurrent ovarian cancer is still a significant problem despite intensive primary therapy, consisting of radical surgery and subsequent chemotherapy. The primary reason for consequent follow up investigations and immediate start of second-line therapy in cases of recurrence is based on the fact, that patients with relapse more than 12 months after primary therapy have a mean survival of 105 weeks after diagnosis. The value of surgical treatment is controversially discussed in the literature. Several authors argue, that there is no definitive prolongation of survival. Between January 1984 and July 1990, 285 patients presented themselves at our hospital with recurrence or progression of ovarian cancer. 72 of these patients had surgical treatment and those patients are part of the investigation. The mean survival of the patients (n = 18), which were operated with no remaining tumour, was 166 weeks. The average survival time of the 22 women with up to 2 cm remaining tumour was 108 weeks. The average survival time of the 32 patients with more than 2 cm after surgery was 72 weeks. One important criterion for the achievable tumour-free situation after surgery was the distinction between primary progression and relapse, where relapse was defined as recurrence more than 12 months after primary treatment. 29% of the patients with relapse could be operated tumour-free, a situation which could be achieved only in one of 13 patients (8%) with primary progression of the disease. Surgery in recurrent ovarian cancer is only indicated in patients with relapse more than 12 months after primary surgery. Tumour-free patients have significant benefit from the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[EGF receptor and EGF-like activity as prognostic factors in cervix cancer].

The binding of the Epidermal Growth Factor (EGF) and the amount of EGF-like activity (EGF-A) was analysed in 75 cervical carcinomas and possible clinical implications were tested. EGF-A was significantly increased in patients with metastases to the pelvic and/or para-aortic lymph nodes. The EGF-receptor (EGF-R) capacity was inversely related to the histological grade (p < 0.05) and was reduced in highly differentiated tumours. In stage I and II disease, the clinical outcome was significantly reduced, if the receptor capacity or the level of EGF-A was increased (> 100 fmol/mg protein and > 0.5 ng/mg protein, respectively). The measurement of EGF-R capacity and EGF-A provides new and additional information for the prediction of the prognosis in cervical cancer.

Biomarkers, Tumor↗
PubMed1993

[Monitoring fetal delivery by oxycardiotocography].

Oxycardiotocography is a combination of cardiotocography and continuous registration of the foetal arterial oxygen saturation (SaO2). In a few cases, the value of this additional information of foetal SaO2 is demonstrated. During uncomplicated deliveries with normal foetal heart rate patterns, the foetal SaO2 usually ranges between 50% and 70%. Uterine hyperactivity with impaired perfusion of the placenta shows besides a changed heart rate patterns, a significant decrease of the foetal oxygen saturation. Conversely, by supplying oxygen to the mother with a mask, the foetal oxygen saturation can be increased by approx. 10%. In case of a breech presentation and application of the sensor to the buttocks, the measured O2-saturation is approx. 10% to 15% below the values usually obtained from the scalp because the tissue there is supplied with mixed blood after the ductus.

Apgar Score↗
PubMed1993

[Value of tumor-reductive secondary operation (interventional laparotomy) in ovarian cancer].

Only 20-50% of patients with advanced ovarian cancer have minimal residual disease after aggressive primary cytoreductive surgery. For patients with residual tumour, responding to platinum-based chemotherapy, new therapeutic procedures should be attempted. In most cases, the benefit of performing secondary surgery could not be clearly demonstrated. But there is a consensus of opinion that a second-look procedure in order to confirm complete remission does not improve survival. Between January 1984 and July 1990, 346 patients with primary ovarian cancer were treated at our institution. 190 patients underwent secondary surgery, 93 of these had secondary debulking and are part of the study. After secondary cytoreductive surgery 38 patients (41%) had no residual disease, 35 patients (38%) had disease less than 2 cm, and 20 patients (21%) had disease greater than 2 cm. Mean survival in patients with no residual disease after secondary debulking surgery was 46 months and significantly longer as in patients with residual disease. Patients with residual tumour at primary surgery and no secondary cytoreductive operation survived 35 months, with a significant difference to the patients with secondary debulking and no residual disease. Secondary debulking surgery should be performed in all patients in whom minimal residual disease can be achieved. Preoperative diagnostic tools, including CA 125 value, computed tomography and immunoscintigraphy, should predict a tumour-free situation after secondary cytoreductive surgery.

Adult↗
PubMed1993

'Blind' transvaginal gamete intra-fallopian transfer in distal tubal and peritubal pathology: an evaluation in respect to the laparoscopic approach.

Transvaginal gamete intra-Fallopian transfer (GIFT) is a new treatment modality for patients with proven tubal patency, avoiding invasive laparoscopy. In this study 79 cycles of standard laparoscopic GIFT (group 1) were analysed in comparison to 40 cycles of transvaginal intratubal gamete transfer guided by tactile sensation (group 2). GIFT in group 1 was performed for standard indications; patients with severe intra-abdominal adhesions, distal tubal pathology, peritubal adhesions or extreme obesity were included in group 2. No difference in mean age, duration of infertility, oestradiol level and number of oocytes was found. In group 1 a clinical pregnancy rate of 33% per GIFT cycle (n = 79) was achieved. The clinical pregnancy rate in group 2 was 17.5% per gamete transfer cycle. In conclusion, transvaginal GIFT offers an acceptable chance for in-vivo fertilization to patients who cannot be treated laparoscopically despite having patent tubes and who refuse in-vitro fertilization.

Adult↗
PubMed1993

Combined intra-uterine and extra-uterine pregnancy in the contralateral tube after gamete intra-fallopian transfer.

A case of combined intra-uterine and contralateral tubal pregnancy after gamete intra-Fallopian transfer (GIFT) is presented. Laparotomy with partial tubal resection was performed after tubal rupture. The intra-uterine pregnancy is still ongoing without complications. Heterotopic pregnancies are dangerous conditions for the patient and should be taken into account after transfer of multiple oocytes. To our knowledge this is the first report of a heterotopic pregnancy in the contralateral tube after GIFT.

Adult↗