[HIV/AIDS disease in gynecology and obstetrics].
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
H Hepp
Publications and source records attributed to H Hepp.
[Intratubal gamete transfer].
Three years' experience with gamete intrafallopian transfer (GIFT) are reported. Between June 1985 and July 1988, 173 clinical pregnancies were achieved in 357 patients over 488 cycles; 34 biochemical pregnancies achieved have not been included. There were 44 spontaneous abortions (25.4%) and 13 ectopic pregnancies (7.5%). Multiple pregnancy occurred in 13.9%. In the group with long-standing sterility without successful treatment, a clinical pregnancy rate of 43.3% was achieved; in cases with andrological subfertility 29.6%; and in cases with genital pathology the pregnancy rate achieved was 31.7%.
Adult↗
[Developments in gynecology--dangers for human dignity?].
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Abortion, Eugenic↗
[Ethical aspects in the treatment of females with cancer].
Ethical aspects in oncology are relevant in four areas: (1) professional competence, (2) patient information, (3) truth and (4) supportive attendance. Professional competence is the ethical imperative in oncology. Only it can mediate between the realms of humanity and technology for the doctor and patient. Extreme opinions on the topic of truth are wrong. Aiding patients in dying, in the sense of aiding them during the process of dying, is aiding them in living. Professional competence, medical responsibility, and humanity are the basis of medical handling. What the doctor does is therefore always concrete philosophy (Jaspers).
Ethics, Medical↗
Serum levels of CA 125 and histological findings at second-look laparotomy in ovarian carcinoma.
In a prospective study, the serum levels of CA 125 were estimated at regular intervals in 139 patients with ovarian carcinoma. Seventy-two of 78 patients with a second-look laparotomy had elevated CA 125 levels initially. The main aim of our investigation was the correlation of CA 125 levels with the histological findings at second-look laparotomy. A total of 26 patients were free from tumor. In each case CA 125 lay within the normal range. From the 46 patients where residual tumor was found, CA 125 levels were elevated in 23 cases, so that in 23 women with residual tumor, false negative levels were found. There were no false positive CA 125 levels. In all women with raised tumor marker levels at the time of the second-look laparotomy, tumor was found despite the often negative clinical or technical preoperative screening. A negative tumor marker at the time of the second look does not exclude residual tumor. For histological proof of complete remission, a second-look operation is imperative. If the CA 125 level is raised, the relevance of the planned second-look laparotomy is open to discussion.
Antigens, Tumor-Associated, Carbohydrate↗
Experiences with SCC antigen, a new tumor marker for cervical carcinoma.
Squamous cell carcinoma (SCC) antigen was first described by Kato et al. in patients with carcinoma of the cervix uteri. SCC serum levels can be measured with a radioimmunoassay. In our investigation, 2.0 ng/ml was taken as the upper limit of the standard range. In 35 healthy women there were no elevated SCC serum levels. Eight of 40 patients with breast, endometrial and ovarian cancer had raised SCC levels. In only two of 12 patients with benign gynecological diseases, SCC was also elevated. Sixty per cent of the patients with primary and 73% of the patients with recurrent cervical cancer showed pathological values; CEA was elevated in 31% and 51% respectively. The absolute values increased with the stage of the disease. Sixty-nine per cent of patients with squamous cell carcinoma had elevated levels. In five of nine adenosquamous carcinomas SCC was pathological. SCC shows a high sensitivity for squamous cell carcinomas of the cervix uteri. The tumor marker might be helpful in the control of primary therapy and follow-up of cervical cancer patients.
Adenocarcinoma↗
[The status of drug prevention of respiratory distress syndrome in German gynecologic clinics].
375 german departments of obstetrics with a total of 258,348 deliveries answered a questionnaire on the actual standards in obstetrical management for the prevention of neonatal respiratory distress syndrome. On the basis of these extensive data, results could be obtained about the time and the regimen of therapy as well as antenatal diagnostics of lung maturity. Furthermore the results document the treatment of high risk pregnancies like multiple pregnancies, diabetes mellitus, gestosis and PROM.
Ambroxol↗
[Experiences with the squamous cell carcinoma antigen, a new tumor marker for cancer of the uterine cervix].
Squamous cell carcinoma (SCC) antigen was first described 1977 by Kato et al. in patients with carcinoma of the cervix uteri. SCC serum levels can be measured with a radioimmunoassay (Abbott), in our investigation 2.0 ng/ml were taken as the upper limit of the standard range. In 35 healthy women there were no elevated SCC serum levels. In only 2 of 50 patients with benign gynaecological diseases SCC was also elevated. 59% of the 102 patients with primary and 70% of the 63 patients with recurrent cervical cancer showed pathologic values, CEA was elevated in 32% and 51% respectively; the mean serum concentrations increased with the stage of the disease. 68% of 142 patients with squamous cell carcinoma had elevated levels, in 5 of 9 adenosquamous carcinomas and in 3 of 14 adenocarcinomas SCC was in the pathological range. 13 of 60 patients with breast, endometrial and ovarian cancer showed elevated values. SCC shows a high specificity and a high sensitivity for squamous cell carcinomas of the cervix uteri. The tumor marker might be helpful in the control of the primary therapy and follow-up of cervical cancer patients.
Antigens, Neoplasm↗
[High grade multiple pregnancy--a clinical and ethical problem in reproduction medicine].
24 patients with high grade multiple pregnancy were admitted to the Department of Obstetrics of the Grosshadern Hospital of the University of Munich between 1984 and 1988. Aetiology, clinical findings and neonatal outcome are presented. With this data as background, the main part of the paper presents and discusses critically three methods of solving this difficult medical and psychosocial problem: 1. prevention, 2. abortion, and 3. foeticide. It is shown that in contrast to killing following prenatal diagnosis, foeticide in high grade multiple pregnancy is unselective. Since every new medical possibility will soon be demanded by society after suitable sociopsychological persuasion and inducement, it is practically an ethical imperative to rightaway prevent high grade multiple pregnancy from occurring.
Abortion, Induced↗
[The value of hormonal and sonographic parameters in the diagnosis of disordered and normal early pregnancy].
In 112 clinical pregnancies after IVF/ET or GIFT, the importance of beta-HCG progesterone and 17 beta-estradiol was evaluated. Additionally, we performed a vaginosonography to confirm an early intrauterine pregnancy. The aim of the study was to define, when a clinical pregnancy can be detected as early as possible and when the differential diagnosis of intact or abnormal pregnancy can be made. By measuring E2 in an HCG substituted cycle, the diagnosis of a clinical pregnancy is possible as soon as day +12 after induction of ovulation. When considering beta-HCG levels alone, the same diagnosis can be made at day +18. Single determinations of HCG level do not offer a satisfactory diagnosis, because of intra-individual variations. A progesterone drop always demonstrates a disturbed early pregnancy. Using a combination of hormonal serial measurements of HCG, E2, progesterone and vaginosonography, the diagnosis of an intact intrauterine pregnancy should be possible as early as day +27 after ovulation induction.
Abortion, Spontaneous↗
[The course of squamous cell carcinoma antigen and CEA as prognostic criteria for response to chemotherapy in cervix cancer].
36 patients with cervical carcinoma were treated with cytostatic drugs in our department between January 1986 and December 1988. Following histological diagnosis by staging laparotomy or by means of a scalenous biopsy, 12 patients received primary chemotherapy and 3 patients received adjuvant chemotherapy following a radical hysterectomy, because of the histological extent of the disease. Twenty-one patients were treated by chemotherapy because of recurrent disease. Treatment consisted at first of a combination of cisplatin and etoposide, followed in August 1987 with a combination of carboplatin and ifosfamide. More than 90% of patients, the SCC, CEA or both tumour markers were elevated before the treatment, so that the course of the tumour markers during chemotherapy could be followed. All patients showed primary response to therapy, the tumour marker levels fell rapidly to normal after one or two cycles. None of these patients showed tumour progression while the tumour marker levels were within the normal range. Clinical remission was not obtained in those patients with levels, which remained high or rose again following an initial decrease. After only two cycles of chemotherapy, levels began to rise further and continuation of therapy did not seem justified. Chemotherapy is often the only available therapy for advanced cervical carcinoma or recurrent disease, even though the results of treatment in squamous cell carcinoma remain poor. The course of SCC and/or CEA levels can help in an early decision, whether or not the patient would profit from a continuation of the therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
[Duration of pregnancy in higher degree multiple birth].
The relationship of birth-weight and gestational age was analyzed in 39 multiple pregnancies (27 x triplets, 9 x quadruplets, 3 x quintuplets). Prophylactic cerclage has no benefit for the duration of the pregnancy. Premature rupture of the membranes was the major indication to delivery (33.3%) followed by maternal (28.2%) and foetal (28.2%) causes.
Cervix Uteri↗
[Differential indications for surgical technics in reproductive medicine--microsurgery, in vitro fertilization and embryo transfer, gamete intrafallopian transfer and tubal embryo transfer].
The birth of the first baby following in-vitro fertilisation and embryo transfer (IVF/ET) in 1978 and the introduction of gamete intrafallopian transfer (GIFT) in 1984 have increased the treatment modalities in operative reproductive medicine. In tubal pathology, there are besides micro-surgery now so-called additive methods available for treating infertility. With regard to the indications, there has been severe confusion, and it is therefore imperative to define special indications for IVF/ET, microsurgery and GIFT. We do not consider these treatment modalities as alternative methods. Reproductive centres should offer all these treatments to guarantee an appropriate individual programme for each couple. Therefore, knowledge of pregnancy rates is a prerequisite for the doctor. The aim of this paper is, to define the optimal therapy while taking into account the individual problems of each couple.
Embryo Transfer↗
Selection of patients for IVF therapy or alternative therapy methods.
Microsurgery is the treatment of choice for most patients with a tubal factor. In-vitro fertilization--embryo transfer (IVF-ET) is performed in patients with the so-called classical indications: bilateral salpingectomy and tubal damage which is not correctable by means of microsurgery. We also discuss IVF in patients who have not conceived within 1 to 2 years following microsurgery. In women with tubal re-occlusion IVF should be performed. In patients with patent tubes following microsurgery, gamete intra-Fallopian transfer (GIFT) forms part of a controlled clinical study. More clinical experience can perhaps solve the dilemma whether it is beneficial to perform GIFT or to offer IVF primarily to these patients. In patients with andrological infertility, GIFT is offered after six unsuccessful attempts of intrauterine insemination (IUI). In long-standing infertility, GIFT is performed when IUI with ovarian stimulation fails. Patients with genital pathology (patent tubes) are treated with GIFT unless it is not technically feasible. In these cases microsurgery or IVF should be discussed.
Embryo Transfer↗
Gamete intra-fallopian transfer in male sub-fertility.
Between July 1985 and July 1987, GIFT was performed in 69 out of 255 patients (87 of 333 treatment cycles) treated because of male infertility. In this group a pregnancy rate of 30% per cycle was achieved, compared to an overall pregnancy rate of 35%. Indications for GIFT include long-standing infertility that has not responded to any other method of treatment, andrological sub-fertility and various forms of genital pathology with patent tubes. These results show that the pregnancy outcome after GIFT in couples with severe male infertility is significantly lower than that following GIFT in patients with long-standing infertility. The pregnancy rates seem, however, much higher than those achieved using intrauterine insemination. In this paper, the results of treating couples with male sub-fertility by GIFT are discussed in detail.
Adult↗
[The course of squamous cell cancer antigen in chemotherapy as a prognostic criterion in cervix cancer].
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Antigens, Neoplasm↗
[The value of prenatal weight estimation in multiple pregnancy].
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Birth Weight↗
[Serum CA 125 values and histologic findings at the time of second-look laparotomy in ovarian cancer].
In a prospective study CA 125 serum levels of 99 patients with ovarian cancer were determined serially. 50 of 55 patients with second-look-laparotomy elevated levels initially had. We were interested in particular in the correlation between CA 125 and the histological findings at second-look operation. In 16 patients there was no residual tumor, CA 125 was in the normal range. In 34 the women tumor tissue was demonstrated; CA 125 was elevated in 14 patients, so there were 20 patients with false negative CA 125 serum levels. No false positive CA 125 values were found. In all patients with elevated tumor marker the residual tumor was histologically confirmed at second look. To verify a complete remission, a second-look operation will have to be performed in spite of a negative tumor marker, since active tumor tissue might still be present. In patients with elevated CA 125 a second-look laparotomy should be avoided at this time.
Antigens, Neoplasm↗