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H Hepp

Publications and source records attributed to H Hepp.

At least 145 records · Page 8Linked to original sources
PubMed1989

[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↗
PubMed1989

[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↗
PubMed1989

[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↗
PubMed1989

[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↗
PubMed1989

[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↗
PubMed1989

[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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1988

[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↗
PubMed1988

[Prognostic factors in the indication for labor induction after previous delivery by cesarean section].

The relative importance of prognostic factors in the management of delivery after caesarean section was investigated retrospectively in 300 patients who gave birth between January 1984 and April 1986. Important factors included the parity of the patient (p less than 0.0001), the number of previous caesareans (p less than 0.001), the Bishop's Score on admission (p less than 0.005) and the indication for the previous caesarean section (p less than 0.05). On our series gestational age (p = 0.042) and estimated birthweight (n.s.) were only marginally statistically significant.

Birth Weight↗
PubMed1987

CA-125 in gynecological malignancies.

CA-125 is an antigenic determinant that can be demonstrated in the majority of epithelial ovarian carcinomas. It can be measured in the serum with a radioimmunoassay by means of a monoclonal antibody. The tumor marker has a low specificity but high sensitivity for ovarian cancer, especially for serous cystadenocarcinoma. In our investigation we were interested in particular in the correlation between CA-125 and the histological findings at second-look operation. In 22 patients, second-look was performed after 6 cycles of chemotherapy, in 16 patients active tumor was demonstrated. In 6 patients with negative CA-125 values, residual tumor less than 1 cm was demonstrated. In order to verify a complete remission, a second-look operation has to be performed. No false-positive CA-125 levels were found. In all patients with elevated CA-125 serum values, residual tumor was histologically confirmed at second look.

Antigens, Neoplasm↗
PubMed1987

[Prenatal diagnosis of non-viable fetuses caused by developmental disorders--an indication for abortion for fetal reasons?].

Between October 1st 1983 and January 31st 1986 we diagnosed various anomalies on 116 foetuses at the Department of Obstetrics and Gynaecology, Klinikum Grosshadern, Munich. In 103 cases we made a correct diagnosis. This group of patients included 45 non-viable foetuses. Severe anomalies of the foetal central nervous system and lethal dwarfism were diagnosed correctly. On the other hand, antenatal diagnosis of bilateral nonfunctional kidneys and non-correctable cardiac malformations poses problems. We feel that in the case of a definitive prenatal diagnosis of an anomaly for which there is no known medical treatment and which is not compatible with life, the decision as to further procedure should be made at this stage. Before 24 weeks gestation, termination of pregnancy on foetal grounds should be discussed with the parents. Thereafter, preterm labour is preferable to the dangers of obstructed labour at term and should be conducted without foetal monitoring.

Abortion, Eugenic↗
PubMed1987

[Pathology of proximal tubal occlusion--morphologic evaluation. Results following microsurgical anastomosis].

Even today, the etiology of proximal tubal occlusion is still a controversial subject. The introduction of microsurgery in gynecology has provided a method of eliminating the main symptom of proximal tubal occlusion, i.e., sterility. Pregnancy rates of 25-30% can be achieved in overall patient collectives. Accurate histologic analyses of the specimens are essential for clinicopathological classification in three prognosis groups. For stage I patients, pregnancy rates of up to 50% (patient-related) can be achieved. Postoperative counseling can thus be differentiated on the basis of the histological results. For stage III patients the pregnancy rate is unlikely to be acceptable, even after waiting for a prolonged period of time. It has not been established whether reconstructive tubal surgery or alternative therapeutic procedures (I.V.F. and E.T.) have better chances of success in stage II. Accurate histologic analysis of the surgical specimens is an essential prerequisite for individualized sterility counseling and therapy.

Constriction, Pathologic↗