Biomedical subjects

H Koelbl

Publications and source records attributed to H Koelbl.

70 records · Page 4Linked to original sources

PubMed1988

Wertheim radical hysterectomy 1921-1986: changes in urologic complications.

In order to assess the incidence and type of urologic complications associated with Wertheim's radical hysterectomy we studied all 154 patients undergoing radical hysterectomy at our department between 1980 and 1986. More than 2/3 of patients had stage I carcinoma of the cervix, the mean age was 46.9 years (range 27-73 years). Various intraoperative reconstructive procedures were required in 5%. A comparison with the experience of Wertheim (before 1919) and that of a subsequent time period (1952-1967) showed that while the incidence of intraoperative injury to the lower urinary tract remained stable, the incidence of postoperative fistula formation decreased significantly (from 6.4% to 0.6%), possibly due to changes in the operative technique. We conclude that Wertheim's radical hysterectomy now involves only a very low risk of injury to the bladder or to the ureter.

Adult↗

PubMed1988

CA 125 in the follow-up of patients with ovarian cancer.

Three hundred and ninety-five CA 125 serum values of 72 patients with ovarian cancer were correlated with the clinical status. With a threshold value of 35 U/ml we found true negative values in 85% and true positive values in 93%. No correlation between preoperative CA 125 values and tumor stage was noted at primary surgery. During follow-up, 17 women had marker values between 35 and 65 U/ml. Three out of 7 women in clinical remission showed a value greater than 65 U/ml at subsequent follow-up and developed recurrent disease. In 8 patients out of 20 re-laparotomies, tumors with a maximum diameter of greater than 2 cm were confirmed with a preoperative serum CA 125 concentration greater than 65 U/ml. Two out of 3 patients with a tumor diameter less than 2 cm at re-laparotomy revealed CA 125 serum concentrations less than 35 U/ml. A false positive CA 125 value was found in one patient without demonstrable active disease. The calculated doubling time of the CA 125 values ranged between 23 and 173 days; the median value was 67 +/- 47 days. After 6.2 +/- 1.3 doubling times death ensued.

Adult↗

PubMed1988

Development and application of simple expert systems in obstetrics and gynecology.

Expert systems have become increasingly popular in medicine for the support of medical decisions, e.g. diagnosis or treatment. We describe the development and application of 2 simple rule-based expert systems, one used for cycle stimulation in our in vitro fertilization program and the other for preoperative assessment of urinary incontinence. The programs were written using a commercially available expert system shell, are run on a standard personal computer, and are in actual use in our department. Though it is doubtful that simple expert systems can be superior to a human expert we feel that expert systems are very useful in the standardization of protocols and are a valuable teaching instrument.

Decision Making, Computer-Assisted↗

PubMed1988

The predictive values of single and combined urodynamic parameters.

We calculated the predictive values of single urodynamic parameters with regard to five urodynamic diagnoses: genuine stress incontinence, mixed incontinence, motor urge incontinence, sensory urge, and no incontinence demonstrable. We now constructed tree diagrams by using the parameters with the highest predictive values (recursive partitioning analysis) and calculated the predictive values of the combinations of parameters in each subset. The tree diagrams and the predictive values of the combined urodynamic parameters offer insights into the relevance of different urodynamic parameters and can be used in developing programs for computer-assisted medical decision making in urodynamics.

Female↗

PubMed1988

Cystosonography: a diagnostic adjunct for the staging of advanced gynecologic malignancies.

Thirty-five patients with advanced gynecologic malignancies (cervical cancer, N = 26; endometrial cancer, N = 5; ovarian cancer, N = 2; vaginal cancer, N = 2) underwent cystoscopy and subsequent cystosonography. The mean age was 61.6 years (range 33-78). The bladder wall was found intact in three patients regardless of the diagnostic procedure. A mere displacement of the bladder wall was observed in four cases using cystoscopy. In all of these women, tumor invasion was ascertained by cystosonography alone. Edema of the bladder mucosa was found in 14 women by cystoscopy and in six women by cystosonography. Endosonography detected tumor invasion of the external layers of the bladder in eight of 14 women. In six of 14 patients, edema was caused by bladder displacement without neoplastic infiltration. Tumor invasion of the bladder was ascertained in six women by cystoscopy and intravesical sonography. Both cystoscopy and intravesical sonography demonstrated neoplastic infiltration and edema of the bladder mucosa in eight patients. Compared with cystoscopy, cystosonographic demonstration of the perivesical region provided better evaluation of the extent of bladder invasion. Cystosonography is a diagnostic adjunct to mere cystoscopy for patients with gynecologic malignancies. This modality is an excellent diagnostic tool, especially if cystoscopy reveals pathologic findings such as edema and displacement or invasion of the bladder wall.

Adult↗

PubMed1988

Increased plasma levels of urokinase-type plasminogen activator with endometrial and cervical cancer.

Plasma concentrations of urokinase-type plasminogen activator (competitive radioimmunoassay), tissue-type plasminogen activator (sandwich enzyme-linked immunosorbent assay), and plasminogen activator inhibitor (functional assay) were measured in 17 women with endometrial cancer and 52 women with cervical carcinoma. Significantly increased plasma urokinase-type plasminogen activator antigen levels were found (11.3 +/- 4.7 ng/mL) in cervical cancer patients when compared with an age-matched control group (7.4 +/- 0.6 ng/mL). Women with endometrial cancer (9.9 +/- 2.0 ng/mL) showed a similar pattern of plasma urokinase-type plasminogen activator antigen levels. Patients with advanced cervical cancer (International Federation of Gynecology and Obstetrics stages III and IV) revealed higher plasma urokinase-type plasminogen activator antigen levels than those with stages I and II disease. Compared with an age-matched control group, neither carcinoma group showed elevated plasma concentrations of tissue-type plasminogen activator and plasminogen activator inhibitor.

Adenocarcinoma↗

PubMedDate not supplied

Development of an expert system for preoperative assessment of female urinary incontinence.

We developed a simple expert system for preoperative assessment of women complaining of involuntary loss of urine and scheduled to undergo surgery for incontinence. The aim of the system was to use the parameters obtained at urodynamic investigation to arrive at the correct diagnosis. We used an IBM-PC with two disk drives and 256k RAM, and the expert system shell EXSYS, a rule based system with the possibility of assigning probabilities to the different solutions. To write the rules forming the knowledge base we used a two-fold approach: we constructed tree diagrams for each diagnosis and calculated the corresponding predictive values (statistical approach), and we added rules based on our experience (heuristic approach). The expert system has been found reliable in a clinical setting and is useful for teaching purposes.

Diagnosis, Computer-Assisted↗

PubMedDate not supplied

CT and MR accuracy in the detection of tumor recurrence in patients treated for ovarian cancer.

OBJECTIVE: The aim of this prospective study was to evaluate the accuracy of clinical examinations (palpation/determination of serum tumor-associated antigen CA125 level), CT, and MRI in the detection of tumor recurrence in patients with treated ovarian cancer. MATERIALS AND METHODS: Twenty-four patients who had been treated for ovarian carcinoma were prospectively examined by clinical means (palpation/serum tumor-associated antigen CA125 level), CT, and MRI to assess their accuracy in detecting recurrent disease; results were correlated with surgical/bioptic/pathoanatomic findings. Nine patients had relapse; 15 women were disease-free. RESULTS: Examinations were true-negative in 14 patients (on palpation/CA125, CT, and MRI) and true-positive in 9 on palpation/CA125, in 6 on CT, and in 7 patients on MRI. False-positive examinations occurred in one patient on palpation/CA125, CT, and MRI and false-negative in zero on palpation/CA125, in three on CT, and in two on MRI, a sensitivity of 100% for palpation/CA125, 66.6% for CT, and 77.7% for MRI and a specificity of 93.3% for palpation/CA125, CT, and MRI. Accuracy of palpation/CA125 examinations was 95.8% in comparison with 83.3% for CT and 87.5% for MRI. CONCLUSION: Our results suggest that in the follow-up of ovarian cancer patients, assessment of serum tumor-associated antigen CA125 level is accurate in the determination of patients with tumor recurrence. Computed tomography is the primary imaging modality to prove macroscopic disease recurrence and can spare these patients from invasive restaging second-look laparotomy; MRI should be performed in women with questionable macroscopic recurrent tumor and negative CT examination. Neither CT nor MRI can confidently exclude microscopic disease.

Antigens, Tumor-Associated, Carbohydrate↗

PubMedDate not supplied

Transforming growth factor beta 1 serum levels in patients with preinvasive and invasive lesions of the breast.

Transforming growth factor beta (TGF-beta)1 is thought to be involved in breast carcinogenesis. TGF-beta1 acts in an antiproliferative manner in the early stages of breast carcinogenesis, but promotes tumor progression and metastases in the advanced stages of the disease. No data have been published on serum TGF-beta1 in breast cancer. We investigated TGF-beta1 serum levels in patients with breast cancer (n=135), ductal carcinoma in situ (DCIS) I to III (n=67) or fibroadenoma (n=35), and in healthy women (n=40) to determine its value as a differentiation marker between malignant, pre-invasive and benign diseases and as a predictive marker for metastatic spread. Median (range) TGF-beta1 serum levels in patients with breast cancer, DCIS I-III or benign breast lesions and in healthy women were 48.8 (18-82.4) pg/mL, 45.3 (26.9-58.3) pg/mL, 47.2 (17.2-80.5) pg/mL and 51.6 (30.9-65.1) pg/mL, respectively (p=0.2). In breast cancer patients TGF-beta1 serum levels showed no statistically significant correlation with tumor stage, lymph node involvement, histological grade, estrogen receptor status and progesterone receptor status. Our data fail to indicate any correlation between serum TGF-beta1 levels and clinicopathological parameters of breast diseases. Serum TGF-beta1 levels do not provide clinical information in addition to established tumor markers.

Adult↗

PubMedDate not supplied

Ectopic lobular breast cancer of the vulva.

BACKGROUND: Primary breast cancer of the vulvar region is a rare tumor entity. Only 12 cases have been published so far in the literature. PATIENT AND METHODS: We report on a case of a 60-year old woman with an invasive lobular breast cancer localized to the vulva. The woman with elevated CA 15-3 and CEA markers underwent local wide excision of the tumor and bilateral inguinal lymphonodectomy, adjuvant anthracycline containing chemotherapy and locoregional irradiation including both inguinal regions and subsequent endocrine therapy with tamoxifen. RESULTS: The resected specimen showed an estrogen receptor-positive diffuse infiltrating lobular breast cancer of the vulva with metastases in both groins. Original tissue of the breast adjacent to the malignant vulvar transformation was lacking. Imaging of the breast was lacking any pathology. Our patient has been followed up for 20 months without any signs of progressive disease. CONCLUSION: Due to the rare occurrence, we are not able to give general guidelines for the treatment of ectopic breast cancer. However, adjustment of treatment to the therapeutic recommendations for orthotopic breast cancer seems reasonable and effective.

Breast Neoplasms↗

PubMedDate not supplied

Immunohistochemistry in stage FIGO III cervical cancer: prognostic value of tumor associated antigens and intermediate filaments.

The prediction of prognosis in cervical carcinomas solely by histological examination is doubtful. Our study was undertaken to evaluate whether Cytokeratin 5D3, Cytokeratin high molecular weight (HMW), Cytokeratin AE1/AE3, Carcinoembryonic Antigen (CEA) and CA 19.9 could have a prognostic value in primarily irradiated stage FIGO III cervical cancer. We investigated 45 pretreatment punch biopsies of cervical cancer stage FIGO III. All patients underwent a combined standardised primary irradiation treatment. In the cases with expression of Cytokeratin AE1/AE3 survival was significantly better than in cases without expression. The expression of CEA also had a significantly positive effect on survival. The best prognosis was found in cases with coexpression of AE1/AE3 and CEA (Wilcoxon p = 0.006, log-Rank p = 0.03). The other investigated tumor associated antigen and intermediate filaments did not correlate with survival. The application of Cytokeratin AE1/AE3 and CEA allows a prediction of prognosis in patients with stage FIGO III cervical cancer undergoing irradiation treatment.

Adenocarcinoma↗

PubMedDate not supplied

Tissue polypeptide specific antigen and cancer associated serum antigen in the follow-up of ovarian cancer.

420 clinical and serological examinations prior to surgery and during follow-up were performed in 30 patients suffering from ovarian cancer. The population consisted of three FIGO stage Ia, nine stage Ic, four stage II and fourteen stage III cases. Serous carcinoma of the ovary, mucinous carcinoma and other kinds of ovarian cancer were found in 16, 9 and 5 cases, respectively. The serum levels of the tumor markers tissue polypeptide specific antigen (TPS), cancer associated serum antigen (CASA) and carbohydrate antigen 125 (CA 125) were determined. Cut-off values of 97 U/l, 4 U/ml and 35mU/ml for TPS, CASA and CA 125, respectively, were selected according to the 95% of serum concentrations measured in healthy controls. Sensitivity, specificity, PPV and NPV of CA 125 were 75%/96%/69%/92%, respectively. Sensitivity, specificity, PPV and NPV of TPS were 67%/84%/59%/90%, respectively. CASA showed a sensitivity of 58%, specificity of 96% and a PPV and NPV of 73%/94%, respectively. The combination of TPS and CA125 increased the sensitivity to 81%, reaching a specificity of 82% and a PPV and NPV of 58/96%, respectively. The combination of CASA and CA125 showed a sensitivity, specificity, PPV and NPV of 88/85/65/96%, respectively. Twelve patients developed recurrence of disease after response to primary treatment. TPS, CASA and CA 125 detected recurrent disease in six, two and four cases, respectively. For TPS mean lead time was 4.6 months (range 2-18 months), for CASA 1.7 months (range 1-6 months), and for CA 125 3.5 months (range 1-24 months. As a matter of fact TPS never showed lead time effects in patients without elevated pretherapeutic levels. A combination of all makers showed a mean lead time of 6.72 months. Detection of recurrent disease by CA 125 is improved when CA 125 is used in combination with TPS, especially in those patients with pretherapeutically elevated TPS serum levels.

Biomarkers, Tumor↗

PubMedDate not supplied

Vascular space invasion and inflammatory stromal reaction as prognostic factors in patients with surgically treated cervical cancer stage IB to IIB.

We assessed the prognostic value of the local tumor characteristics inflammatory stromal reaction (ISR) and vascular space invasion (VSI) together with established prognostic criteria, in cervical cancer patients. One hundred and forty-two patients with carcinoma of the cervix stage IB to IIB undergoing radical hysterectomy and lymphadenectomy between October 1980 and September 1990 were included in the study. Pelvic lymph node involvement, stage, parametrial involvement, age and histological tumor type were analysed together with VSI and ISR as prognostic factors. The most important prognostic parameters for recurrence-free interval and overall survival in the univariate analysis were pelvic lymph node involvement (P-value < 0.0001/0.0001) and stage (P-value < 0.0001/0.0005). ISR and VSI showed a significant prognostic value for recurrence-free interval (both P-values = 0.0014) and overall survival (ISR: P-value < 0.0001; VSI: P-value = 0.0018). In the multivariate analysis ISR showed an independent prognostic value for overall survival (P-value = 0.03, Relative Risk = 5.4, 95%-confidence interval 1.2-24.5). ISR, reflecting the biological behavior of the tumor, should be considered in the evaluation of prognosis in surgically treated squamous cell carcinoma of the cervix.

Adult↗

PubMedDate not supplied

Expression of the adhesion molecule CD44v3 is a prognostic factor in vulvar carcinoma.

Our aim was to evaluate the prognostic value of CD44v3 overexpression in vulvar cancer patients. Twenty-five cases of squamous cell carcinoma of the vulva with International Federation of Gynecology and Obstetrics (FIGO) stages I to III were examined for overexpression of the CD44 isoform CD44v3. The correlation of CD44v3 overexpression with clinical stage, histologic grade and overall survival was investigated. Follow-up ranged from 36 to 120 months. Clinical stage and histologic grade did not correlate with CD44v3 overexpression. CD44v3 overexpression was associated with poorer overall survival (log rank: P < 0.03). Immunohistochemically detected CD44v3 overexpression is significantly correlated with a reduced overall survival rate for patients with vulvar carcinoma.

Adult↗

PubMedDate not supplied

The serum tumor marker M3/M21 in the follow-up of breast cancer patients.

The aim of this study was to evaluate the new serum tumor marker M3/M21 in comparison to CA 15-3, CEA and MCA in the follow-up of breast cancer patients. We investigated 267 serum samples from 35 patients suffering from invasive breast cancer, International Union Against Cancer (UICC) stage pT1 to pT4. Cut-off values for M3/M21, CA 15-3, CEA, and MCA were 25 U/I, 30 U/I, 5 ng/ml and 11 U/I, respectively. Serum tumor marker results were correlated with the results of the clinical and radiological examinations. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of serum CA 15-3, CEA and MCA were 47/85/61/76%, 24/90/55/70% and 39/84/55/73%, respectively. Serum M3/M21 showed a sensitivity of 45%, specificity of 81%, PPV of 73% and NPV of 69%. The combination of CA 15-3 and M3/M21 increased the sensitivity to 55%, with a specificity, PPV and NPV of 83%, 79% and 86%, respectively. CA 15-3 measurements showed a lead time effect in 5 patients, ranging from 3 to 7 (median 4.1) months. The combination of CA 15-3 and M3/M21 provided lead time effects in 7 cases, ranging from 2 to 8 (median 5.7) months. We conclude that the detection of breast cancer recurrence with CA 15-3 is improved by combination with M3/M21.

Antigens, Tumor-Associated, Carbohydrate↗

PubMedDate not supplied

Prostate specific antigen (PSA) in breast and ovarian cancer.

Prostatic specific antigen (PSA) is commonly used for the diagnosis and monitoring of prostatic adenocarcinoma, and has recently been detected in breast cancer and it is also thought to be produced by ovarian cancer. To examine the prognostic value of PSA tumor expression, we investigated the tumor cytosols of 26 patients with breast cancer and of 16 women with ovarian cancer. We used a chemiluminescence immunoassay for the quantitative determination of PSA (detection limit 0.003 ng/ml). The median PSA level in breast cancer patients was 0.31 ng/mg (minimum 0.003, maximum 4.4). PSA expression was significantly lower in poorly differentiated breast cancers compared to moderately and highly differentiated tumors. Advanced lymph node metastases were also correlated with lower PSA expression. We found no correlation with relapse free or overall survival. Median PSA level in our ovarian cancer patient collective was 0.014 ng/mg (minimum 0.003, maximum 0.046). We found a significant correlation between PSA expression and the estrogen receptor content of the tumor. PSA expression showed no correlation with histological grading, tumor size or other tumor characteristics in ovarian cancer. There was no correlation with relapse free or overall survival in ovarian cancer patients. Our study demonstrates that PSA is expressed in ovarian malignancies but at a lower level compared to breast cancer tissue. PSA was not able to identify a subset of patients with good prognosis in breast and in ovarian cancer patients.

Adenocarcinoma↗