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H Pickel

Publications and source records attributed to H Pickel.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Total hysteroscopic endometrium resection: a critical analysis of indications, technique and results].

130 total hysteroscopic resections of the endometrium (RE) were performed at the Department of Gynecology and Obstetrics of the Deutschlandsberg Hospital from August 1, 1992 to May 31, 1997. 115 patients (88.5%) suffered from distinctive therapy-resistant uterine bleeding in terms of hypermenorrhea and menorrhagia, frequently combined with poly- and dysmenorrhea. 15 (11.5%) women who had previously been operated for breast cancer developed--during continuous treatment with tamoxifen--endometrial hyperplasia or polyps on which RE was performed after a hysteroscopic biopsy or resection had been carried out in a second setting. The operation showed that 98 out of 115 patients (85.2%) had pathologic anomalous uteri which were the organic cause of the uterine bleeding. Only 17 women (14.8%) suffered from dysfunctional uterine bleeding (12 cases) or from iatrogenically reduced coagulability (5 cases). The majority of the women (106 cases = 81.5%) were older than 40 (average 46.9 +/- 6.21 years). All RE were performed under inhalation anesthesia whereby the complete uterine cavity up to the inner orifice of the uterus was resected with the resectoscope loop. 92 out of 130 patients (70.8%) underwent a hysteroscopy or a dilatation and curettage before the RE. 77 patients (66.9%) received pretreatment with drugs to reduce the endometrium. 15 women (13.0%) underwent a laparoscopic tubal sterilization in the same setting. Finally, the results of 107 patients were analyzed excluding dropouts and patients who had undergone continuous treatment with tamoxifen and those who had an observation time of less than 6 months. After an observation period of 6-58 months, the success rate was 84.1%. For treatment of relapses 7 second resections were performed, whereby in 1 patient with a further uterine bleeding the uterus had to be extirpated. Nine of the 10 remaining patients had a hysterectomy, 1 patient refused any further treatment. The total hysterectomy rate was 12.2%. Basically, RE is absolutely practicable as far as the treatment of abnormal uterine bleeding is concerned, since hysterectomy can be avoided in a number of cases. Satisfactory long-term results, however, can only be achieved if indication and operation technique are of high quality. A problem which has not yet been solved is the indication and treatment of proliferating adenomyosis uteri interna.

Adult↗
PubMed1997

Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy.

BACKGROUND AND PURPOSE: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This restrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. MATERIAL AND METHODS: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB-IVB) received EBR to the pelvis (ave, max. dose 48.8 Gy) followed by 1-6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). RESULTS: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P = 0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. CONCLUSION: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.

Brachytherapy↗
PubMed1997

Prognostic factors in cervical cancer.

The inadequacy of clinical methods has spurred efforts to develop objective, measurable and reproducible parameters for the spread and growth behaviour of cervical cancer. Morphological methods were applied first. They can be used only on the surgical specimen, but are accessible to biometry. The presented results are based on 479 surgical specimens obtained at radical abdominal hysterectomy for cervical cancers of different sizes. The specimens were processed as frontal giant sections with the cervix, the vaginal cuff and the parametria on both sides. The median follow-up time was 7-8 years. Statistical correlations were found between follow-up data, biometric morphologic criteria and survival. The statistical ranking of the significant prognostic factors produced the following order: lymph node metastases, size of lymph node metastases, tumour volume, parametrial involvement and vascular invasion.

Cell Differentiation↗
PubMed1997

[Choriocarcinoma of the uterus after term pregnancy: imaging by vaginal color Doppler ultrasound].

A 29 year-old woman presented with continuous metrorrhagia and a positive pregnancy test 3 1/2 months after vaginal birth. Transvaginal sonography showed a 3.5 x 4 x 4 cm mostly echogenic uterine mass with diffuse myometrial invasion in the right fundal region. Colour Doppler sonography revealed extensive low impedance flow in the periphery of the mass suggestive of a trophoblastic tumor. Histological examination of curettage specimens revealed a chorionic carcinoma. The tumor size as measured by magnetic resonance imaging correlated well with that by sonography. Trophoblastic disease after a normal pregnancy is rare. Early diagnosis can be facilitated by transvaginal colour Doppler sonography.

Adult↗
PubMed1997

Primary serous papillary carcinoma of the peritoneum: a report of 18 patients.

Eighteen patients with primary papillary serous carcinoma of the peritoneum (PPSCP) were treated at the Department of Obstetrics and Gynecology of the University of Graz between 1980 and 1996. Primary tumours from other sites, particularly the pancreas and ovary, had been excluded. Because of extensive spread of the disease particularly in the upper abdomen, seven of the 18 patients (38%) underwent exploratory laparotomy only. Median overall survival time was 10 months (range 1-28+). This figure reflects the extent of spread of the disease at diagnosis on one hand, and that optimal cytoreductive surgery (residual disease < or = 2 cm) was possible only in six of the 18 patients (33%) on the other. The six patients with optimal cytoreduction had a better survival (range 4+ to 28+ months) than those who underwent less radical surgery. These data indicate, that, similar to primary ovarian cancer, the amount of residual disease may be an important prognostic factor in patients with PPSCP.

Adult↗
PubMed1996

[Early invasive cervix carcinoma--FIGO 1994].

7078 histological cases of cold-knife conisation have been reevaluated. Because of the changes of the FIGO 1994 staging system, all microinvasive cancers in that material have been reclassified. This had major histomorphological and clinical consequences.

Cervix Uteri↗
PubMed1995

Diagnostic value of gonadal steroid hormones and gonadotropins in ovarian cystic lesions.

During a 12-mo period the fluid aspirated from 32 ovarian cystic lesions was assayed for 17 beta-estradiol (E2), progesterone (P), testosterone (T), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). All cysts were subsequently subjected to histologic or cytologic examination. In 84.6% (11/13) of the proven follicular cysts, the E2 content was greater than 100 pg/ml, in 76.9% (10/13) the P content was greater than 13 ng/ml, and in 69% (9/13) the T content was greater than 0.5 ng/ml. In 94.7% (18/19) of the ovarian cysts of other types, the E2 content was less than 100 pg/ml and the P content was less than 13 ng/ml. The FSH and LH contents of both types of cysts were variable, and no consistent pattern was discerned. In contrast, cytologic examination identified 69.2% (9/13) of the follicular cysts. In conclusion, consideration of the E2 and P contents with cytologic examination allowed the identification of all follicular cysts. Accordingly we recommend the estimation of E2 and P as part of the assessment of all ovarian cyst aspirates obtained from premenopausal patients.

Adult↗
PubMed1995

Solitary metastasis in the tarsus preceding the diagnosis of primary endometrial cancer. A case report.

A solitary metastasis in the left tarsus led to the diagnosis of primary endometrial cancer in a 61 year-old patient with no history of postmenopausal bleeding. Lower leg amputation, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymphadenectomy were performed. Histopathology showed a well-differentiated endometrioid adenocarcinoma of the uterus with a low mitotic rate, but infiltration of the outer third of the myometrium and lymph vessel invasion (FIGO Stage IVb). Immunostaining was positive for progesterone receptors, but negative for estrogen receptors and p53. The lymph nodes were free of metastases. Ascites was positive for malignant cells. Postoperatively the patient received carboplatin, cyclophosphamide and medroxyprogesterone acetate and is alive with no evidence of disease 10 months after diagnosis.

Adenocarcinoma↗
PubMed1994

Cold-knife conization versus loop excision: histopathologic and clinical results of a randomized trial.

Ninety patients with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 38) or cold-knife conization (n = 52). All specimens were well evaluable at histology. The average width of the lesions at histology was 10.2 and 9.7 mm, respectively (ns). The average weight of the specimens was 2.6 and 5.6 g (P < 0.01) and the average depth was 9.2 and 15.8 mm (P < 0.01), respectively. The distance between the cervical resection margin and CIN was 14 mm after loop excision and 24 mm after cold-knife conization (P < 0.06). The margins of the specimen were not clear of disease in 8 patients after loop excision and in 12 patients after conization (ns). Two patients after loop excision and in three patients after cold-knife conization had postoperative bleeding. The results suggest that, compared with cold-knife conization, loop excision removes less healthy tissue without reducing the chances for cure.

Adult↗
PubMed1994

Small FIGO stage IB cervical cancer.

The International Federation of Gynecology and Obstetrics (FIGO) currently defines stage IA cervical cancer as lesions invading up to 5 mm into the stroma and with no more than 7 mm width; vascular invasion does not affect the stage assignment. The Society of Gynecologic Oncology (SGO) definition of stage IA is more restrictive with regard to depth of invasion but ignores width. We reviewed 69 patients with lesions exceeding the FIGO definition of stage IA treated between 1958 and 1991; 46 patients also exceeded the SGO criteria for stage IA. The frequency of vascular invasion showed no correlation with the depth of invasion but was correlated with the width of the lesion. Treatment consisted of conization or simple hysterectomy only (n = 27), radical abdominal hysterectomy with lymphadenectomy (n = 25), radical vaginal hysterectomy (n = 13), and conization followed by radiotherapy (n = 4). No patient developed a recurrence during a follow-up of 2-35 years. Two of the 25 patients with lymphadenectomy had one positive lymph node each. The first patient had a primary lesion with 3 mm invasion and 17 mm width, no vascular invasion, and one node metastasis 2 mm in diameter; the second had a lesion with 4 mm invasion and 10 mm width, vascular invasion, and a tumor-cell embolus in the marginal sinus of a node. These results indicate that the problems involved in treating microinvasive carcinoma of the cervix also apply to cases of small stage IB disease. It will not be possible to devise a staging system that simultaneously serves as a guideline for treatment. The current FIGO classification of stage IA2 should be expanded rather than restricted.

Adult↗
PubMed1994

Lymphadenectomy in stage I ovarian cancer.

OBJECTIVE: Our experience with systematic lymphadenectomy in stage I ovarian cancer (defined as intraabdominal disease confined to the ovaries) was reviewed. We analyzed whether it would be possible to predict lymph node metastases on the basis of clinical-morphologic factors at the time of surgery. STUDY DESIGN: Forty of 100 evaluable patients operated on between 1980 and 1990 underwent comprehensive surgical staging, including total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and systemic pelvic +/- paraaortic lymphadenectomy. RESULTS: Nine of the 40 (23%) patients who underwent lymphadenectomy were found to have lymph node metastases; five of these were < or = 2 mm in maximum diameter. Four of the nine patients with positive nodes had ovarian tumors with a maximum diameter of only 5 cm, eight had grade 2 or 3 tumors, and eight tumors were classified as serous cystadenocarcinomas. Other clinical-morphologic factors such as ascites, adherence, or extracystic excrescences did not predict lymph node metastasis. Four of the nine patients with positive nodes survived > or = 5 years with no evidence of disease. CONCLUSIONS: Lymph node metastases, some < r = 2 mm in diameter, occur in an appreciable percentage of patients with intraabdominal disease confined to the ovaries. Clinical-morphologic factors at surgery cannot be relied on to predict the status of the lymph nodes. Thus we cannot recommend limiting lymphadenectomy to any specific subgroup of patients with intraabdominal disease confined to the ovaries.

Adult↗
PubMed1993

Pelvic and parametrial lymph nodes in the quality control of the surgical treatment of cervical cancer.

Between 1971 and 1989 a total of 420 patients underwent radical abdominal hysterectomy with pelvic lymphadenectomy at our hospital for stage Ib, IIa, or IIb cervical cancer. The entire lymph node material was processed in serial sections and stained with hematoxylin and eosin. Lymph nodes were counted and the sizes of metastases measured. The entire surgical specimen was fixed as a whole with the parametria spread out. The size of the tumor was measured by morphometry. Cases treated between 1971 and 1979 were compared with those treated between 1980 and 1989. The median number of pelvic lymph nodes removed per patient was 24 between 1971 and 1979 and 35 between 1980 and 1989 (P = 0.0001). Significantly more nodes were removed at each node group (P = 0.01). Between 1971 and 1979 no common iliac nodes were obtained in 56 patients and no left common iliac nodes in 74 patients, compared to only 1 and 6 patients, respectively, between 1980 and 1989. The rate of patients with positive lymph nodes was 33% (63/195) between 1971 and 1979 and 55% (101/225) between 1981 and 1989 (P = 0.008). In the first study period the median number of parametrial lymph nodes was 2 compared to 3 in the second period. The rate of patients with positive parametrial lymph nodes increased from 15 to 24% (P = 0.027). The results of this review indicate that exacting morphologic processing of the entire lymphatic tissue obtained at surgery permits accurate postoperative staging and assessment of risk factors for decisions on adjuvant treatment. Histologic evaluation objectifies the radicality of the procedure and is useful in the quality control of the surgical treatment of cervical cancer.

Female↗
PubMed1993

Specific rearrangements of human papillomavirus DNA provide molecular evidence for genetic heterogeneity of primary cervical cancers, recurrencies, and lymph node metastases in two patients.

Two different characteristic patterns of human papilloma virus (HPV) type 16 DNA were found by Southern blot hybridization in four pelvic and paraaortic lymph node metastases in a patient with FIGO stage IIIb cervical cancer. Both patterns added up to give the HPV 16 DNA pattern of the primary tumor. This strongly suggests that the tumor was composed of two distinct compartments, each spawning its own lymph node metastases. A second patient presented with a vaginal tumor 4 years after stage IIb cervical cancer had been treated with hysterectomy only. The vaginal tumor was removed and pelvic lymphadenectomy performed. Integrated HPV 16 DNA was found in the vaginal tumor whereas one involved and one free lymph node contained episomal HPV 16 DNA with a characteristic deletion. The apparent heterogeneity of the cancer cell population may indicate that the metastasis is not related to the vaginal tumor but that it is a late sequel of the cervical cancer. Alternatively the metastasis could have originated from an unsampled portion of the vaginal tumor.

Adult↗
PubMed1993

Histopathology of the fallopian tube after local instillation of hyperosmolar glucose solution for unruptured tubal pregnancy.

Because of an incomplete tubal abortion, salpingectomy was performed in a patient 12 days after glucose instillation into an ampullary tubal gestation. Serum hCG levels had progressively declined from 1.122 mIU/mL at first intervention to 37 mIU/mL at the second operation. Histopathology showed marked necrosis of trophoblastic tissue but no discernible damage of the tubal epithelium and tubal wall attributable to the hyperosmolar solution applied 12 days before. This case offers histopathologic evidence that intraluminal glucose instillation for treatment of unruptured tubal pregnancies does not lead to persisting damage of the tubal mucosa.

Adult↗