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60 cases of sarcoma of the uterine body were treated at the Ist Department of Obstetrics and Gynaecology, Vienna University, during the period 1960 to 1971. Treatment consisted of combined surgery and irradiation (37 cases), surgery alone (8 cases) and irradiation only (14 cases). The 5-year survival rate was 53.3%.

A group of 1018 patients with gynecological malignancies after a combined or primary radiation therapy was studied for frequency and space of recurrence. In the first three years after therapy in cases with cervical cancer 95%, in cases with endometrial cancer 82% and in cases of ovarian cancer 98% of all recurrences were diagnosed. In cases of cancer of the vagina, the tube and vulva all recurrences were observed within the first three years. By results obtained it is put up for discussion to replace "five-years-rate" by "three-years-rate" in cases of gynecological malignancies with exception of mammary carcinoma. Thereby the value of a model of therapy could be realized earlier than hitherto.

A report is given on the excretion of variation of-aminolaevulinic acid (ALA) as an index of the lead load in pregnant women at term and at one and also at four weeks after delivery in both mothers and the newborn infants. The mean values in women were 7.2 + 3.7 before delivery 9.0 + 4.1 one week and 4.1mg ALA/1 urine four weeks after delivery; mean values of 5.2 + 3.2 one week after birth and 2.2 + 1.0 mg ALA/1 urine four weeks after birth were recorded in the newborn infants, according to the method of Davis and Andelman. Two groups were set up: mothers coming from the rural environs of Vienna and mothers living in the centre of the city. The ALA excretion was 14% lower in the former group (20% four weeks post partum) as compared with the mothers living in the city. When these data are considered against a threshold value of 10 ALA/1 urine (set up by the "Hauptverband der Berufsgenossenschafen", Bonn, West Germany, using the same method) the mean value of 9.0mg ALA/1 urine (with individual values of up to 17.4mg ALA/1 urine) in mothers one week after delivery already seems extremely serious.

At the radiotherapy unit of the Ist Department of Gynaecology, University of Vienna, 8500 malignant tumours were observed in the years 1950-1975. Multiple primary neoplasms were recorded in 204 of these cases (2.4%). In 76 women (37.2%) the double neoplasms were situated in the genital region (local multiplicity), whilst in 128 cases the second neoplasm was situated in a distant organ, with cancer of the breast predominating (61 cases = 29.9%). A third of the multiple neoplasms were diagnosed simultaneously, whilst in the remaining two thirds a peak occurrence in the first year before or after the diagnosis of the gynaecological neoplasm is observed. Seven cases of triple neoplasms are presented as a separate group. Our observations are compared with the appropriate literature.

The method of choice for stimulation is extracorporeal radiotherapy of the blood, which has undergone stepwise clinical experimental development, is recommended. Implementation of this method induces a marked increase in the biosynthesis of certain serum proteins, especially the IgM and IgG fractions of the gammaglobulins and there is a definite tendency to normalization of certain serum enzymes in patients with cervical carcinoma. The dose dependence observed in the present study and the good clinical tolerance shown to this radiotherapeutic procedure are emphasized. The investigation is concluded with a cautions appraisal of the possible mode of action of extracorporeal X ray-irradiation of the blood at a dosage of 5000 R/O.

During the years 1960-1974 out of 1002 patients with endometrial carcinoma 256 underwent primary surgery and 846 primary irradiation. The evaluation of the results of 4 different surgical methods showed despite a different distribution of the stages of the cancer that Werthein's operation and abdominal hysterectomy and adnexectomy with simultaneous lymphnodectomy had statistically significant better results than abdominal hysterectomy without lymphonodectomy. By surgery a 5 years survival time was achieved in 83.6% (214 cases) with a primary mortality rate of 0.39% and an incidence of histologically proved lymphnode-metastases of 6.78%. Out of the 846 patients with generally or locally inoperable endometrial carcinomas, who underwent primary intracavitary irradiation 411 (48.6%) achieved a 5 years survival time. After irradiation in 9.9% reversible reactions (severe proctitis and cystitis) and in 2% irreversible complications (fistulas) were observed. After an observation period of 5 years 625 of the total of 1002 treated patients (62.4%) were alive and free of symptoms.

This paper first reviews the relatively abundant literature on crystallization phenomena in human secretions, then our experiments, aimed at artificial imitation, are discussed. Threadlike crystals appear when the inorganic share of the solution shows 530mg% NaCl and 70mg% KCl and the organic one either 34mg% hyaluronic acid or 200 to 500mg% glucose. By overstepping the concentration limit of glucose or human albumin, crystallization can be prevented. The prevention of crystallization by proteins might gain some significance in diagnostic cytology as a primitive method to analyse colloid semiquantitatively.

By a high dose gestagen therapy following primary radiation therapy of endometrial carcinoma it was possible to reduce the recurrence-rate 12 months after therapy in comparison with a control-group without gestagen therapy by more than 50%. Therefore this method is recommended not only for treatment of far advanced carcinoma of the endometrium but also as prophylactic therapy in cases of early endometrium cancer.

The histomorphological changes in the bone marrow were investigated in 9 patients treated by primary irradiation for cervical cancer. Bone marrow specimens were obtained by the Yamshidi puncture technique from the spina iliaca posterior superior after radiotherapy with different radiation dosages, as well as four months after termination of radiotherapy. All patients showed disappearance of almost all the haematopoietic cells in the irradiated area and, with the exception of one patient, no repopularization of the bone marrow or fibrosis. The possible mechanisms leading to these results are discussed and comparisons with the international literature are drawn.

We report 24 cases of sarcoma of the corpus uteri treated by sole irradiation. The 5-year-survival-rate was 20,8%. The prognosis seems to be poor in this group treated by sole irradiation. Only inoperable cases of sarcoma of the corpus uteri ought to be treated by radiotherapy alone.

A historical review is presented of the foundation of the radium ward of the 1st Gynaecology Department of the University and its development into the Radiotherapy Department of the 1st and 2nd Gynaecology Departments of Vienna University. Altogether 8500 patients with gynaecological carcinomas were treated primarily by irradiation over this period and 75.000 post irradiation outpatient follow-up examinations were carried through. This report includes laudatory statements by Prof. Antoine, Prof. Gitsch and Prof. Kärcher on the 25th anniversary of the department.

Between 1951 and 1970, 263 cases with primary carcinoma of the vagina were observed at the Irradiation-Department of the Ist University Clinic of Obstetrics and Gynecology in Vienna. As method of choice the individual, fractioned and protracted Radium-Röntgen-Telekoalt-therapy is recommended. Of the 263 primary vaginal carcinomas 112 (42,5%) were cured. During the time mentioned in this report, we did not have any primary mortality; 24 women, however, could only be subjected to a palliative therapy, 20 patients died from an intercurrent disease and 20 women succumbed to a second carcinoma. Conclusively, the authors present a survey about the results in vaginal carcinoma.

In cooperation with the Austrian National Institute for Statistics the incidence-rates of breast cancer in Austria in the period of 1971-1975 were investigated. The incidence-rate of breast cancer (50 new cases/year/100,000 women) is higher than the incidence-rate of cervical or endometrium carcinoma. The increasing risk of the higher age-groups, which is especially expressed by the incidence-rate of 145 in the age-group of 70 or more years, is pointed out. This findings are of great consequence to the system of preventive medical care. In urban areas the incidence of breast cancer seems to be higher than in rural district.

The rates of endometrial carcinoma incidence in Austria were investigated for the period between 1971 and 1975 by the authors in cooperation with the Austrian National Institute of Statistics. The incidence of corpus carcinoma has increased also in Austria over the past decades, as may be seen from the ratio between corpus carcinoma and cervical carcinoma which is 1:1.9 at present. Age related incidence was studied, as well, with continuous growth in incidence having been observed along with growing age. In women aged between 60 and 69, corpus carcinoma was almost as frequent as cervical carcinoma, and it was predominant among women of 70 and above. The findings obtained from age group surveys have also suggested that irradiation therapy rather than primary surgery was required for more than 50 per cent of the patients reviewed.

In spite of the increasing interest in geriatric-operative therapy primary irradiation therapy still has its important place in the treatment of cervical cancer in cases of higher age. About every third patient with cervical cancer belongs to the age group over 60 years, which is more or less excluded from operative therapy. The advantage of irradiation therapy is to be seen in the low post-therapeutic mortality and the remarkable survival and healing rates.

After the enumeration of every single problem encountered in the geriatric gynecology, it has been proved, that the malignant tumors of such cases are of a special significance. according to the epidemiological facts of the Austrian Cancer-Registration-Statistics between the years 1971--1975 (even if the cancer of cervix uteri is excluded) more than 60% of the cases are still seen in the geriatric group. Increasing risk (by rate of incidence) of malignant tumors of internal genitals or the breast in aged women is also known and is proved to be very specific. Inspite of the progress won in geriatric surgical gynecology, the post-operative complications are still the negative factors, which limitate the success. Therefore today radiotherapy of the malignant tumors especially in geriatric-gynecological patients is gaining more and more importance.

The cases of 627 women with gynaecological malignomas, who were primarily irradiated in 1967 to 1969, were interpreted, questioning the temporary difference between clinical and histological diagnosis and beginning of treatment with regard to five-years' healing-results and mortality. The study has demonstrated, that - a delay of only four weeks considered - the part of living patients waas 11,28% of the total number of living patients, the part of dead patients however was 21,62% of the total number of dead patients. We emphasize therefore the urgency of an immediate beginning of therapy following a reliable diagnosis.

In a further series of experiments, the same effect was found with cobalt-60-treatment as with X-ray-irradiation: the data determined by means of iodin-bromine-consumption in the methanolic serum-extract showed the same changes under equal exterior conditions at three different points of time. Corresponding to a diminished average dose of the cobalt-60-teletherapy, the humorally realized shock-reaction was reduced.

In cooperation with the Austrian National Institute for Statistics the incidence rates of cancer of the cervix uteri in Austria in the period of 1971--1975 were investigated. Not only the different federal countries but also the political districts were concerned by this study. The main findings were a relative high rate of women less than 40 years of age and severe regional differences. Problems in the registration of incidence rates of cancer are pointed out.

For statistical processing of data resulting from irradiation of gynecological cancer a system of EDP working off-line is presented. Not only healing and survival rates will be evaluated but also data about the morbidity of irradiated patients. Thereby the employed therapy should be improved. Moreover, the patient follow-up can be supervised by a special program with automatical summoning of negligent patients.

A report is given of an increase in urinary delta-aminolaevulinic acid (ALA) excretion in patients with cervical carcinoma treated by extracorporeal radiotherapy as well as with radium and telecobalt. It was found, that 16 out of 17 patients showed an increase of 125% (on average) in the elimination of ALA on the seventh day after irradiation. A return to noraml ALA-values was found in nine patients 42 days after radiotherapy whilst in six patients a further increase in ALA elimination occurred in comparison with the values recorded on the seventh post-irradiation day. The possible causes of the lead elimination, indicated by the ALA test, as well as the possibility of lead as an aetiological factor in tumour genesis are discussed.

The usual method of irradiation in the therapy of the carcinoma corporis uteri is described. It is stressed, that none but inoperable carcinomas were irradiated: this means, of course, a negative selection in disfavor of the radiotherapy. A report is given of 802 cases of carcinoma of the corpus uteri, treated by primary radiotherapy in the 1st University Clinic of Obstetrics and Gynecology in Vienna in the years 1950-1970. The 5-years-survival rate in this period was 50.4%. In the last half decade of this period the 5-years-survival rate of 300 patients went down to 48.6%. The reduction of this survival rate may be caused by the increasing age of the patients, who underwent therapy and is corresponding to world-wide experiences. Additive therapies like the "second-look abrasio" for early diagnosis of a local recidivation and the gestagen therapy for the prevention of metastatic carcinoma of the corpus uteri are discussed.

The endogenous oestrogen state in 52 women (33 with endometrial carcinoma and 19 with benign conditions of the endometrium) was assessed ny means of histological examinations of vaginal swabs and of radio-immunological determinations of 17 beta-oestradiol. Considering their age, these women displayed an oestrogen activity far exceeding that found in previous studies. There was no difference between the oestrogen levels in women with carcinoma and the other patients. Furthermore, it was stiking that in the same group of women the examined parameters frequently showed different results. Consequently, a diagnosis based solely on the investigation of one parameter must frequently be misleading.

In former papers it was stated that the fetus can be exposed a considerable burden by traces of heavy metals and that a combined therapy with calcium phosphate and ascorbic acid has a good detoxifying effect. In fourty lead-burdened mothers who were treated in this way the excretion of 5-aminolevulinic acid in urine decreased by 65%, the lead content of placenta by 90% and the lead content of mother's milk by 15% compared with a control group without treatment. The cadmium content of the placenta was reduced to 4% of the content in untreated mothers.