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H Hetzel

Publications and source records attributed to H Hetzel.

At least 37 records · Page 2Linked to original sources
PubMed1987

Clinical significance of neopterin for prognosis and follow-up in ovarian cancer.

Neopterin, a pyrazinopyrimidine compound, is a marker of activation of cell-mediated immunity. The prognostic value of pretherapeutically and of serially measured urinary neopterin levels in patients with ovarian cancer was assessed, in a blinded manner, by analysis of 658 urine specimens from 74 women. The specimens were collected during a 5-year period (January 1981 to January 1986). Thirty-one deaths due to cancer were observed during the study period. By statistical analysis, a significant predictive value of pretherapeutic neopterin levels was found and compared with that of other possible prognostic clinical and laboratory findings. Multivariate analysis, using stratification by tumor stage, demonstrated that this predictive information was independent of other variables. A significant association was found between serial neopterin measurements and the current risk of death during follow-up (P less than 0.0001). In addition, current death risk was correlated with neopterin levels measured 6 months previously (P = 0.026). The histological outcome at surgical reexamination was correlated with the current neopterin levels (P = 0.016). Further, normal neopterin levels in women with evidence of tumor at surgical reexamination were shown to be a sign of better prognosis than elevated levels. Measurement of urinary neopterin levels during follow-up of women with ovarian cancer appears to be a valuable adjunct to conventional techniques, particularly in patients refusing explorative surgery.

Biopterins↗
PubMed1987

[Status of surgery in therapy of cervix cancer].

Between 1969 and 1980 296 patients with cervical cancer were treated by surgery in our department and some were given postoperative irradiation. The five-year survival rate was 96.2% in stage I a cases and 85.2% in stage Ib. The surgically obtained specimens were evaluated for tumour extension and lymph node spread. These parameters were examined for their prognostic value. The tumour size correlated with the five-year survival rate. Lymph node spread was found in 1% of stage Ib cases. Intraoperative complications were seen in 2.4% of patients. Postoperative complications appeared in 44%. Late complications were found in 19.1%. Diagnostic conisation is of predominant value for the adequate surgical management of cervical cancer stage Ia and borderline stage Ib cases. Our own results and comparable data of other authors allow the following guidelines to be laid down for the operative treatment of early invasive cervical cancer: In stage I a: When the tumour volume is less than 1 mm3 (early stromal invasion according to Lohe) simple hysterectomy (in special cases possible only conisation) is sufficient. Microcarcinoma (tumour size less than 10 X 10 X 5 mm) is best treated by the conventional Wertheim operation. When tumour invasion of blood or lymph vessels is diagnosed, additional lymphadenectomy must be performed. In stage Ib-IIa: Radical operation according to the Latzko technique is advisable.

Adenocarcinoma↗
PubMed1987

[Simplified HDR-afterloading and high-voltage therapy of cervical carcinoma].

In continuation of our long-term afterloading method applied in the treatment of patients with inoperable cervix carcinomas, we have introduced the ring and pin applicator system into the short term afterloading proceeding. The benefit of a standardized treatment method is especially relevant in HDR afterloading therapy. A time-consuming brachytherapy planning is not necessary because of the constant source distribution within the rigidly shaped ring and pin applicator and the unchanged dose to point A according to Manchester. Percutaneous radiotherapy planning is further facilitated by fixing a metal clip in the cervix at the first HDR insertion. With the aid of anterior-posterior localization radiography, the centre of the circular absorber used by us can be located on the metal clip. In case of an asymmetric position of the cervix, this allows to avoid a dose excess at one pelvis wall caused by superimposing target volumes of brachytherapy and percutaneous therapy as well as an insufficient dose at the opposite wall of the pelvis.

Brachytherapy↗
PubMed1987

[Rectal shielding for a Selectron-ring applicator system (HDR- and LDR-afterloading)].

In order to decrease the morbidity rate after combined radiotherapy of the cervix carcinoma, a tungsten shield 3 and 5 mm thick for the rectum has been developed by the authors which is applied with the ring and pin applicator of the Selectron unit (LDR- and HDR-afterloading). The isodose curves were measured in a plexiglas phantom, and the radiation dose at the reference points was determined by means of a ionization dosimeter. The phantom measurements were performed with the same arrangement of sources as applied in radiotherapy. The measurements showed a dose reduction at point Rmax of 33% (HDR) and 44% (LDR) with the tungsten shield 5 mm thick.

Brachytherapy↗
PubMed1987

Determination of neopterin in serum and urine.

Concentrations of neopterin, a product of activated macrophages, in serum from 662 apparently healthy individuals (ages 1 to 97 years, median 22 years) were measured by radioimmunoassay and the results statistically analyzed. Consistent with prior investigations on the urinary excretion of neopterin, we found no significant sex dependence, but values for subjects younger than 18 or older than 75 years were significantly higher. Renal clearance of neopterin in nine healthy individuals was 218 (SD 44) mL/min, which suggests that the kidneys have an active role in neopterin excretion. Results for neopterin concentrations measured in serum by RIA and "high-performance" liquid chromatography (HPLC) are consistent, but for urinary neopterin the concordance between methods was weak. Therefore, the RIA should be used only for measuring neopterin in serum. In comparison of the clinical utility of serum neopterin and urinary neopterin/creatinine concentrations, in patients with gynecological tumors, the latter values (measured by HPLC) discriminated slightly better between patients with favorable and unfavorable prognoses.

Adolescent↗
PubMed1986

[Simplified standardized afterloading therapy of cervical cancer using a new applicator system (modeled after the Munich method)].

In order to be able to continue to benefit from the Munich method - fixed applicator geometry - even after changing from radium therapy to low dose rate afterloading therapy, our department has developed a standardized treatment program for the ring applicator. Its prerequisites are the dose specified on the Manchester point A and the distribution of sources specified for the ring applicator. The make-up of the source flow in the ring catheter is chosen in such a way as to reduce the maximum rectal dose to more favourable levels.

Brachytherapy↗
PubMed1986

[Standardized low-dose-rate afterloading therapy of cervical cancer using a ring applicator].

At our hospital, the Munich method has already proved its value in gynecologic brachytherapy. In order to use this method for the afterloading technique (LDR), too, we developed a computer program for a standardized therapy with the circular applicator. A certain arrangement of sources is indicated for all applicator sizes. So the dose prescribed (point A) as well as the treatment times and the maximum rectum doses can be given in tabular form. Furthermore, another reduction of the exposure of the rectum could be achieved by means of a certain symmetric arrangement of the sources. To our opinion, this standardized treatment scheme allows in most cases a sufficiently exact definition of the dose distribution in the pelvis minor. If necessary, a more individualized irradiation planning can be established later using CT scans.

Brachytherapy↗
PubMed1985

Neopterin, a biochemical indicator of cellular immune reactions, in the detection and control of patients with neoplastic diseases.

The incidence of elevated neopterin levels is presented for 748 patients with various malignancies. The mean urinary neopterin levels varied directly with stage and in patients with carcinoma of bladder according to histological grade of disease. In 178/208 patients with subsequent treatment for gynecological cancer, neopterin levels returned to normal within 3 weeks when tumor remission was achieved but remained high or even raised when persistent or recurrent cancer was later diagnosed. In 160 patients suffering from cervical carcinoma, significant differences in survival were demonstrated by Cox regression when patients were grouped according to their pretherapeutical neopterin level.

Adolescent↗
PubMed1983

Measurement of urinary neopterin in normal pregnant and non-pregnant women and in women with benign and malignant genital tract neoplasms.

Urinary neopterin was measured in healthy women (n = 209) and men (n = 208), in patients with benign gynecological tumors (n = 53), in women with precancerous lesions of the cervix and the endometrium (n = 24) and in women with cancer of the genital tract (n = 108). In addition urinary neopterin measurements were made in 109 pregnant women and 20 women in the puerperium. No significant difference was found between mean neopterin values in patients with benign gynecological tumors, in women with precancerous lesions and in healthy women. Patients with cancer had significantly higher mean urinary neopterin levels than the control group. Raised neopterin levels were found in 56% of patients with genital tract cancer, the figures varying between 93% for ovarian cancer and 47% for cancer of the cervix. Some of the cancer patients had serial urinary neopterin measurements and in about 80% there was some relation between urinary neopterin values and clinical progress as judged clinically and radiologically, the best agreement existing in patients with ovarian cancer. Significantly higher mean neopterin values were found during normal pregnancy and in the early puerperium than in non-pregnant healthy controls. Raised urinary neopterin excretion may be due to enhanced cell proliferation and alloantigenic activation of T-lymphocytes.

Adolescent↗
PubMed1983

Significance of urinary neopterine in gynecological oncology: follow-up of patients with ovarian cancer.

In patients with genital cancer (N = 108) significantly higher mean neopterine levels were found than in a healthy control group. Prior to therapy elevated neopterine levels were seen in 60% of the patients with cancer of the genitals varying between 90% (ovarian cancer) and 54% (cervical cancer). Nine patients with ovarian cancer (stages IIb-IV) were followed for a period of 16 months to date. All patients had elevated neopterine values prior to therapy. When the urinary neopterine excretion remained increased over the period of observation, progression of the tumor occurred within a few months. In patients with complete or partial remission of the tumor, the neopterine excretion dropped to normal values. Thus, we feel that neopterine sampling may be helpful in the follow-up of patients with ovarian cancer, as tumor progression is indicated very early, before clinicoroentgenological findings are present.

Adult↗
PubMed1982

Urinary neopterine excretion in patient with genital cancer.

Urinary neopterine values in 96 healthy women were compared with those in a group of 63 patients with cancer of the genitals who had not yet undergone treatment. Significantly higher median neopterine levels were found in the patients with carcinoma (p less than 0.001). In the 63 cancer patients who had not yet been treated, the diagnosis was made correctly in 65% of the cases by monitoring neopterine levels. In the follow-up of 72 patients with cancer of the genitals in 74% the neopterine values corresponded with the clinico-roentgenological findings. In 22%, false positive neopterine values (no recurrence of the tumor), and in 4% false negative values (recurrence, or progression of the carcinoma) were observed. These results confirm previous reports concerning the significance of pteridine excretion in patients with cancer. However, more investigations have to be performed to establish the value of neopterine sampling in monitoring patients with malignant tumors.

Adult↗
PubMed1982

Rehabilitation of micturition in patients with incomplete spinal cord lesions by transurethral electrostimulation of the bladder.

Since the first description of the method of transurethral electrostimulation by Katona in 1956, controversial opinions have been published. In contrast to other types of electrical bladder stimulation the physiological basis for this method of treatment is the stimulation of receptors in the bladder wall. With the help of forceful stimuli damaged neurons may be activated leading to clinical success. This report presents our results over a 4-year period using stimulation parameters other than those published to date and studying the effects objectively by using urodynamic techniques. The results obtained in 30 adults with neurogenic bladder disturbance due to incomplete traumatic cord lesions will be presented under the following headings; development or alteration of bladder sensation or of detrusor contraction, the achievement of bladder control and the efficiency of micturition as shown by the decrease of residual urine. The method is helpful in the restoration of micturition in patients with incomplete traumatic spinal cord lesions: 26 out of 30 patients gained perfect bladder sensation, 25 of them achieved satisfactory bladder contractions, 28 ended the stimulation program with a residual below 50 cm3 and 17 out of 30 gained perfect bladder control, 10 others became at least socially dry without need for pads or urinals.

Adolescent↗
PubMed1981

[Functional disturbances of the lower urinary tract following radical surgery for cervical cancer (author's transl)].

1972 to 1977 141 patients at the university department of gynecology and obstetrics in Innsbruck had radical abdominal hysterectomies according to Latzko because of carcinoma of the cervix uteri state I-IIa. 111 (78.8%) patients without recurrence of carcinoma were investigated without recurrence of carcinoma were investigated in the period of 2 to 36 months after operation in a modern urodynamic testing unit to state functional troubles of the lower urinary tract. We judged the sensibility of the bladder, the incidence of urinary incontinence, residual urine determinations and the frequency of infections of the lower urinary tract after radical hysterectomies. In particular we were interested in the urodynamic investigation (spontaneous flow rate and uroflow-metrie after bladder filling, liquid cystometry and simultaneous measurement of the pressure in the rectum for a faithful expression of the detrusor pressure). Based on these investigations we could indicate a typical type of troubles after radical abdominal hysterectomies, which partly depends on lesions of the autonomous nerval system of the lower urinary tract. 89.5% of all these patients within the first year after operation could not feel any desire to void although the bladder was full. Longer than one year after operation we could find the same symptom in 45.5%--recovery in part seems to be possible. Moreover we could find unnoticed urinary loss, residual urine and infections of the lower urinary tract (24.7%) in higher incidence compared with a control group. Because of our investigation we could work out advice for prevention and therapy of functional troubles of the lower urinary tract after radical abdominal hysterectomy.

Female↗
PubMed1979

[Caesarean section: low transverse (pfannenstiel) or midline incision? (author's transl)].

In 67 elective Caesarean sections and 70 emergency sections the effect of the duration of anaesthesia upon the condition of the newborn was examined. The induction-delivery time (IDT), the operation time (OT), and the difference between these, delta t, were correlated with the 1-, 5- and 10-minute Apgar scores and the pH's of the venous and arterial umbilical cord blood. A highly significant negative association was found for the pH in the umbilical vein and delta t in the series of primary sections. Analysis of the emergency sections showed a negative association between the operation time and the 5 minute Apgar score, and a positive association between the delta t and 1 minute Apgar score. Despite these findings we have observed that the induction-delivery time which we are able to achieve in our hospital has no negative effect upon the biochemical condition (pH) of the newborn. A comparison of 619 sections performed by low midline incision with 328 section by Pfannenstiel incision showed no difference with regard to postoperative complications such as disturbance in wound healing or haematoma formation. In conclusion, with respect to the IDT and postoperative complications we have found no contraindication to the use of the low transverse Pfannenstiel incision for Caesarean section.

Apgar Score↗