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Biomedical subjects

O Reich

Publications and source records attributed to O Reich.

At least 19 recordsLinked to original sources
PubMed2007

[Pathoanatomical preparation and reporting for dysplasias and cancers of the cervix uteri: cervical biopsy, conization, radical hysterectomy and exenteration].

A careful macroscopic description with selection of representative tissue for histological examination is required for quality assurance, for assessing prognostic factors and for answering legal questions in (pre)cancerous lesions of the cervix uteri. Exact and standardized gross inspection and preparation are decisive for the quality of the histopathological statement. The extent of cervical carcinomas should be given in three dimensions, including the relative depth of invasion into the cervical wall. The report should include size, type (according to the WHO classification) and grading of the tumor, the presence of lymphatic as well as blood vessel invasion and perineural involvement. The statement for resection margins should include the vaginal, parametrial, rectal and vesical directions. It is also mandatory to document the number of lymph nodes with metastatic disease in relation to the total number of nodes investigated. The staging should follow the TNM system. In the handling of conisation specimens, it is important to appropriately document localization, horizontal expansion, depth of invasion including microinvasion of any dysplastic or malignant lesions. Clockwise dissection of the conisation specimen, total submission, and step sections are recommended. The preparation of exenteration specimens is a highly skilled job: the exact tumor dimension should be given in its relation to all resected organs and structures with special focus on resection margins.

Biopsy↗
PubMed2006

[Painless enlargement of the scrotum].

Painless swelling of the scrotum may be due either to an increase in bulk of the scrotal contents or to changes affecting the skin of the scrotum. The reliable and rapid differentiation of harmless from serious conditions such as cancer of the testicles, is essential.

Adult↗
PubMed2006

[Benign prostatic syndrome (BPS). Ablative treatments].

Today, the surgical treatment of the benign prostatic syndrome (BPS) often follows a course of drug treatment. Besides conventional transurethral resection of the prostate (TURP), which has represented the standard therapeutic option for decades, and its in part significant modifications ("vaporizing resection"; bipolar resection), much of the interest has shifted to alternative instrumental procedures like transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA) or several laser techniques. By reviewing the current literature, preferably from randomized controlled trials, these different procedures are critically assessed. Moreover, the present role of open prostatectomy is discussed.

Endoscopy↗
PubMed2006

[Photoselective vaporization of the prostate: experience with prostate adenomas >80 cm3].

BACKGROUND: We report about our experiences with photoselective vaporization of the prostate (PVP) in patients with symptomatic benign prostatic hyperplasia (BPH) and total prostate volume larger than 80 cm(3). PATIENTS AND METHODS: The study included 201 patients with BPH: 51 (25.4%) patients had a prostate volume larger than 80 cm(3) and 150 (74.6%) patients had a volume smaller than 80 cm(3) in the preoperative transrectal ultrasound. RESULTS: The mean operation time for patients with large prostates was 79 min. Neither TUR syndrome nor severe bleeding was observed. In patients with large adenomas peak urinary flow increased by 135, 136, and 132% after 6, 12, and 24 months, respectively. The overall complication rate was comparable in both groups. CONCLUSION: PVP is characterized by excellent perioperative safety and significant improvement of voiding parameters. PVP is feasible in patients with large prostates.

Aged↗
PubMed2006

Survey of adjuvant hormone therapy in patients after endometrial stromal sarcoma.

INTRODUCTION: We surveyed the use of adjuvant hormonal therapy in patients with endometrial stromal sarcomas. MATERIAL AND METHODS: A questionnaire was circulated among the 130 members of an Internet-based endometrial stromal sarcoma support group. The questions pertained to age at diagnosis, organs involved at diagnosis, recurrences, metastases, current disease status, and treatment protocols, with special focus on hormonal therapy. RESULTS: The questionnaire was returned by 64 of 120 women (49%). At the time of the study 48 patients (mean follow-up 2.4 (range, 1-9) years) had no evidence of disease (NED) and 16 (mean follow-up 6.2 (range, 1-22) years) were alive with disease (AWD). Of the 16 women AWD, 15 (95%) were being treated with hormones as opposed to ten of 48 (21%) women with NED. Hormone treatment consisted of progestins (15 patients), aromatase inhibitors, aromatase inhibitor plus GnRH analog], or tamoxifen. DISCUSSION: Adjuvant hormonal therapy presently appears to be used predominantly in women with advanced or recurrent endometrial stromal sarcomas but is also a potential option for patients after surgery without residual tumor.

Adult↗
PubMed2006

Recurrent endometrial stromal sarcoma after treatment with high-dose chemotherapy and autologous stem-cell support: A case report.

INTRODUCTION: The efficacy of high-dose chemotherapy plus transplantation of autologous hematopoetic stem cells in patients with endometrial stromal sarcomas is unknown. CASE REPORT: A 39-year-old woman with Stage III endometrial stromal sarcoma (ESS) underwent radical surgery, followed by five courses of ifosfamide, adriamycin and dacarbazine postoperatively. Six months after primary surgery stem cell priming was performed. Five months later bone marrow was aspirated and high-dose chemotherapy with carboplatin, vepeside and holoxan were administered after which bone marrow was retransfused. Seven years after primary surgery the patient developed an abdominal recurrence which was removed surgically and adjuvant radiotherapy was administered. One year later the patient underwent hemicolectomy because of a new recurrence infiltrating the ascending colon. Treatment with 25 mg exemestane was begun. The patient is currently alive and free of disease nine years after the initial diagnosis. CONCLUSION: Aggressive chemotherapy with autologous stem-cell support seems to be ineffective in patients with ESS.

Adult↗
PubMed2005

Retroperitoneoscopic living donor nephrectomy: a comparison with the open approach in respect of early postoperative pain management.

INTRODUCTION: We retrospectively compared perioperative donor outcomes and early postoperative pain control after retroperitoneoscopic (RLDN) and standard open (OLDN) living donor nephrectomy. METHODS: One hundred donors included fifty after RLDN (37 women/13 men) and 50 after OLDN (35 women/15 men) were retrospectively analyzed for basic analgesics, for opioid consumption, and for visual analog scale (VAS) to verify the experienced pain. The donors were questioned in the morning and evening of the first through fifth postoperative days. RESULTS: The mean age of both groups was equal. The mean operating time was 149.7 +/- 48.2 minutes (60 to 270) for RLDN and 164.1 +/- 30.3 minutes (60 to 240) for OLDN (P = NS). The mean warm ischemia time was 120 +/- 36 seconds (50 to 240) and 114 +/- 31 seconds (60 to 190) for the RLDN and OLDN groups, respectively (P = NS). The mean evening VAS for RLDN versus OLDN on postoperative days 1 to 5 was: 2.1 versus 2.2 (P = NS), 0.9 versus 1.8 (P = .009), 0.5 versus 1.3 (P = .016), 0.1 versus 0.7 (P = .013), and 0.1 versus 0.7 (P = .013), respectively. In both groups there was a tendency toward a higher VAS score in the morning than in the evening. RLDN donors showed significantly earlier period free of pain (VAS = 0) than those after OLDN. There was a significant difference of being free from any opiate between both groups after surgery. CONCLUSIONS: After RLDN donors experienced less postoperative pain than after OLDN over the early postoperative days. Therefore, postoperative regional anesthesia is not necessary for donors operated by a retroperitoneoscopic approach.

Adult↗
PubMed2005

Early vulvar lichen sclerosus: a histopathological challenge.

Vulvar lichen sclerosus (LS), a lymphocyte-mediated chronic skin disease, begins with uncharacteristic symptoms and progresses undiagnosed to atrophy and destructive scarring. Some patients with longstanding advanced LS have an increased risk of vulvar carcinoma. Early LS is treatable, although not curable, if diagnosed early. Therefore, patients with persistent vulvar symptoms should be biopsied to establish the diagnosis. In contrast to advanced LS, the histological features in early LS are quite subtle and often more prominent in adnexal structures than in interfollicular skin. Adnexal structures show acanthosis, luminal hyperkeratosis and hypergranulosis with/without dystrophic hair and basement membrane thickening. The epidermis/mucosa shows mild irregular, occasionally psoriasiform acanthosis and focal basement membrane thickening. Early dermal changes are homogenized collagen and wide ectatic capillaries in dermal papillae immediately beneath the basement membrane. The lymphocytic infiltrate can be sparse or dense, lichenoid or interstitial with epidermal lymphocyte exocytosis and lymphocytic/lymphohistiocytic vasculitis. Dermal melanophages indicate preceding keratinocyte/melanocyte destruction. Biopsy specimens of early LS rarely display all features. Therefore, serial sections and periodic acid-Schiff reactions are necessary for their identification. Recognition and treatment of these early stages of LS may result in longstanding remission. Progression to atrophic stages with their associated morbidity and even to squamous cell carcinoma may be prevented.

Adult↗
PubMed2005

Coagulation profile and liver function in 102 patients after total cavopulmonary connection at mid term follow up.

OBJECTIVE: To examine coagulation factors and liver function test abnormalities in patients after total cavopulmonary connection (TCPC). DESIGN: Cross sectional study comprising clinical and echocardiographic evaluation, and biochemical and coagulation profile screening. SETTING: Tertiary referral centre. METHODS: 102 patients aged 4-24 years (median 10 years) at one to eight years (median five years) after TCPC were examined. All patients were maintained on a low dose of aspirin. 96% of patients were in a good clinical condition (New York Heart Association class I or II). No intracardiac thrombi were detected on echocardiography and ventricular function was good in 91% of patients. RESULTS: Total bilirubin was increased in 27% and gamma glutamyltransferase in 54% of patients. Serum total protein, albumin, and prealbumin were normal in almost in all patients. Compared with the control group, patients after TCPC had significantly lower fibrinogen, factor V, factor VII, and protein C concentrations, prolonged international normalised ratio, and increased antithrombin III concentration. Factor V concentration was abnormally decreased in 35%, factor VII in 16%, and protein C in 28% of patients. Antithrombin III was increased in 23% of patients. Factor VII, factor V, protein C, and antithrombin III correlated significantly with serum prealbumin. There was also a significant correlation between procoagulant factor VII and both anticoagulant protein C and antithrombin III. CONCLUSIONS: Almost half of patients after TCPC had laboratory signs of mild cholestasis. Decreased liver synthesis of procoagulant and anticoagulant factors was observed but overall coagulation homeostasis appeared to be in balance in this selected group of patients with a good clinical outcome.

Adolescent↗
PubMed2005

[Is early first intercourse a risk factor for cervical cancer?].

Sexual behavior has long been known to be a risk factor for cervical carcinoma. Certain sexual risk factors are related to an increased risk of chronic infection of the cervical transformation zone with high-risk human papilloma viruses (HPVs). Numerous retrospective analyses consider early first intercourse a probable risk factor for later development of cervical carcinoma. Since risk factors are associated, it is unclear whether early first intercourse is an independent risk factor for cervical neoplasia. Few comprehensive retrospective studies are available. It is possible that the cervical transformation zone is particularly vulnerable to infection between menarche and the age of sixteen. During this phase there are a large number of undifferentiated cells at the periphery of the metaplasia, practically at the surface of the cervix. It seems that this area is particularly susceptible to HPV infection. There are also indications that there is no secondary immune response to HPV at the time of early first intercourse, making the immune response to HPV less efficient. Other possible risk factors for cervical cancer include genetic predisposition, nutrition, smoking, Chlamydia or HSV-2 infections, drug abuse, oral contraception, immune suppression and early first pregnancy. Education appears important to encourage responsible sexual behaviour in young people.

Adolescent↗
PubMed2005

Endometrial stromal sarcoma--observational evidence of a genetic background?

BACKGROUND: Endometrial stromal sarcomas (ESS) constitute only 0.2% of all gynecological malignancies, and risk factors or genetic associations are largely unknown. We are in contact with more than 100 patients with ESS via an internet support group, and our aim was to analyze the personal and familial medical histories of this large patient group for possible familial cancers aggregations in ESS patients. METHODS: A questionnaire regarding the personal and familial medical history was circulated among the members of the internet group, which was returned by 64 patients. RESULTS: At diagnosis of ESS the average age was 42 years. Fifty percent had a history of long-term hormonal treatment. One patient each had a previous history of breast carcinoma, thyroid cancer and cutaneous malignant melanoma. One familial case of ESS was observed. At least one malignancy in the family was reported by 47% of patients, and the mother or father were affected in 26%. Multiple familial cancers were observed in 25% of ESS patients. The most frequent familial cancer was breast cancer (25%) followed by endometrial (8%), lung (7%) and prostate carcinoma (5%). CONCLUSIONS: Patients are young, report hormonal treatments and have a familial history of hormone-dependent carcinomas. This suggests a strong genetic predisposition in the oncogenesis of ESS. Patients with ESS may suffer from an inherited genetic predisposition similar to familial breast and prostate carcinoma which may render them susceptible to hormone-dependent growth promotion and/or to cellular damage from particular estrogen metabolites of endometrial cells resulting in a ESS.

Adult↗
PubMed2004

Small-cell carcinoma of the uterus and the vagina: experience with ten patients.

BACKGROUND: Small cell carcinomas (small-CCs) of the uterine cervix are rare and highly malignant neoplasms. Patients tend to develop distant metastasis early and thus are potential candidates for systemic therapy. We reviewed the experience with small-CCs of the uterus and vagina at two Austrian University hospitals. MATERIAL AND METHODS: Ten patients (median age, 50 years; range, 18-92) with small-CC of the cervix (n=7), uterine corpus (n=2), and the vagina (n=1) were treated at the two centers between 1988 and 1998. Eight patients underwent radical surgery, 7 of whom also received chemotherapy. Two additional patients underwent primary radiotherapy. RESULTS: All Pap smears were suspicious for cervical malignancy. The median survival was 12 months (range, 6-86) and overall 5-year survival was 10%. Five of 8 surgically treated patients had lymph node involvement (62%). Of the 7 patients with small-CC of the cervix only one, who had FIGO stage IIB disease and positive pelvic nodes, survived long-term (86 months) with no evidence of disease. She had received six courses of dose-intensive platinum chemotherapy after radical surgery. All three patients with small-CC of the uterine corpus or vagina developed recurrence within the first year after diagnosis. Of the 7 patients who received chemotherapy, 5 developed progressive or recurrent disease in the paraaortic region (n=2), peritoneum (n=1), liver (n=1), or pelvis (n=1). CONCLUSION: These results confirm the particularly unfavorable prognosis of patients with small-CC of the genital tract. The optimal treatment for these patients most probably including concurrent chemo-radiotherapy remains to be defined.

Adolescent↗
PubMed2004

[Vulvar lichen sclerosus. The importance of early clinical and histological diagnosis].

Vulvar lichen sclerosus (LS) is a chronic progressive skin disease of unclear etiology. It is often overlooked in early stages, but progresses to destructive atrophy and is associated with an increased risk of vulvar squamous cell carcinoma. The classical symptoms are pruritus and pain, but they are often not distinctive, so that unclear vulvar problems often lead to a biopsy. The histological picture of early LS is quite different from that of late LS with an atrophic epidermis, markedly sclerotic dermis and stiff dilated vessels. The epidermis in early LS is usually normal with only minor irregularities in the rete pattern. The basement membrane is normal or focally widened, while the edematous dermis has only scattered ectatic vessels. The often dense lichenoid and intraepidermal infiltrate explains the spongiosis and vacuolization of the basal layer keratinocytes. Very early cases may only have a sparse lymphocytic infiltrate and hyper-/parakeratosis of the follicular ostia. Early topical therapy can dampen the progression to atrophic, irreversible LS.

Adult↗
PubMed2004

[The 80 W potassium-titanium-phosphate (KTP) laser vaporization of the prostate. Technique and 6 month follow-up after 70 procedures].

BACKGROUND: Despite good efficacy, even in our days, TURP remains a potentially difficult procedure to perform and is associated with significant risks for the patient. Several alternatives have been tried to reduce the known perioperative morbidity. We report our first experiences with 80 W potassium titanyl phosphate (KTP) laser vaporization of the prostate in patients with symptomatic BPH. PATIENTS AND METHODS: In 70 patients 80 W KTP laser vaporization was performed successfully. Mean age was 70.5 years (46-93 years) and mean transrectal prostate volume was 48.1 ml (10-250 ml). RESULTS: Mean operating time was 41 min ( n=22), 64 min ( n=33), and 80 min ( n=15) for a 26 ml, 46 ml, and a 91 ml prostate, respectively. At time of discharge, after 1 month, and 6 months the urinary peak flow increased by 75.4%, 166.8%, and 168.6%, respectively. CONCLUSION: The 80 W KTP laser vaporization of the prostate combines the tissue-debulking properties of transurethral resection of the prostate with the known good hemostatic properties of other laser procedures. It is a safe procedure for the patient and provides a virtually bloodless operation and immediate improvement of voiding.

Aged↗
PubMed2004

Vasculitis in lichen sclerosus: an under recognized feature?

AIMS: To analyse 90 vulvar and 72 penile cases of lichen sclerosus (LS) on haematoxylin and eosin sections for vascular changes and the vascular infiltrates immunohistochemically with antibodies to T cells, B cells and antigen-presenting dendritic cells. LS is a skin disease of presumed autoimmune origin. Autoimmune diseases are mediated by lymphocytes which occasionally produce a lymphocytic vasculitis. METHODS AND RESULTS: Three types of lymphocytic infiltrates were identified: (i) perivascular lymphocytic infiltrates without damage to vessel walls; (ii) lymphocytic vasculitis in three forms: (a) concentric lymphohistiocytic infiltrates with lamination of the adventitia by basement membrane material which was typical for penile LS; (b) lymphocytic vasculitis with dense perivascular lymphocytic cuffing with occasional fibrin deposition in vessel walls and subendothelial lymphocyte infiltration, quite common in vulvar LS; and (c) intramural lymphocytic infiltrates in large muscular vessels; (iii) leukocytoclastic vasculitis in LS was exceptionally rare. In lymphocytic vasculitis, CD20+ B cells, CD4+ T cells and dendritic cells were the principal infiltrating cells. CONCLUSIONS: Dendritic cells capture (foreign) antigens after entry into the affected tissues and initiate immune responses acting as a matrix on which antigen-specific T and B cells interact. The described vascular features are indicative of antigen-mediated vasculitic changes in LS.

Adult↗