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[Intracytoplasmic inclusions within cells of the breast and their diagnostic significance (author's transl)].

There were 700 tissue biopsies of the breast with and without carcinomas examined simultaneously by intraoperative histology and imprint cytology. In 20.2% of the cases with carcinoma the tumor cells showed peculiar intracytoplasmic inclusions, whereas in only 0.43% of the biopsies of the mamma without carcinoma such inclusions were to be found. Their morphologic variation and the histochemical pattern are discussed. It is pointed out that these intracytoplasmic inclusions may be a helpful histopathologic feature in the diagnosis of breast cancer.

Breast↗

[Comparison of the psychosocial benefits of augmentation and reduction mammaplasty in women. Retrospective study of 122 women].

Plastic surgery procedures are being increasingly used on the female mammae. Our study involved procedures for reduction or augmentation of breast size in 83 and 39 noncancer patients, respectively. In order to answer the question of whether more psychosocial benefits are to be expected in reduction or augmentation operations, the following aspects were explored in patient interviews: social, personality/psychological, sexual satisfaction, professional and leisure time, and honest evaluation of the results. These data should have bearing on focussing the preoperative explanation of the operation to the patient.

Breast↗

[Bone cement containing cytostatic drugs: new aspects in the treatment of malignant bone tumors. I. Experimental studies].

Radical surgery in malignant bone tumors can either be limited by anatomical structures or seems inadequate in the palliative stabilization of bone metastases. Incomplete removal of the tumor and stabilization by compound osteosynthesis or endoprosthesis contains two problems: 1) the wide spread of malignant cells by manipulation in the tumor bearing area; 2) progressive destruction of bone due to remaining tumor. To overcome these problems we developed methotrexate bone cement (MTX-Palacos) with the aim to obtain high local concentrations of methotrexate in order to destroy remaining tumor cells and avoid systemic side effects. In vitro studies showed that methotrexate is released continuously from this cement without relevant changes of its biomechanical properties. Animal studies with transplanted osteosarcomas and mamma carcinomas in mice showed a considerable decrease of tumor growth when a plug of MTX-Palacos was inserted in the center of the tumor. Histological findings showed that in the surroundings of the plug the tumor was destroyed considerably contrary to normal bone cement which had no effect on the tumor at all. The results are discussed with regard to clinical application of MTX-Palacos.

Animals↗

Visualization of the thymus by substance P receptor scintigraphy in man.

Substance P, an 11-amino acid neuropeptide, has an important role in modulating pain transmission through neurokinin 1 and 2 receptors. Substance P and other tachykinins may also play a role in the pathogenesis of inflammatory diseases. In this study we present the results concerning the metabolism of the substance P analogue [111In-DTPA-Arg1]-substance P in man, as well as the visualization of the thymus in patients with immune-mediated diseases. Twelve selected patients were investigated, comprising five with inflammatory bowel disease, one with ophthalmic Graves' disease, one with sclerosing cholangitis, one with Sjögren's syndrome, one with rheumatoid arthritis, one with systemic lupus erythematosus and two with myasthenia gravis. During and after intravenous administration of 150-250 MBq (2.5-5.0 microg) [111In-DTPA-Arg1]-substance P, blood pressure, heart rate and oxygen saturation were monitored. Radioactivity was measured in blood, urine and faeces during the 48 h after injection. Planar and single-photon emission tomographic images were obtained 4 and 24 h after injection. After administration of [111In-DTPA-Arg1]-substance P, a transient flush was observed in all patients. Degradation of [111In-DTPA-Arg1]-substance P started in the first minutes after administration, resulting in a half-life of 10 min for the total plasma radioactivity, and of 4 min for the intact radiopharmaceutical, as identified with high-performance liquid chromatography. Urinary excretion accounted for >95% of the radioactivity within 24 h post injection, and up to 0.05% was found in the faeces up to 60 h. In all patients uptake of radioactivity was found in the areolae mammae (in women), liver, spleen, kidneys and urinary bladder. In eight patients a high uptake of [111In-DTPA-Arg1]-substance P was observed in the thymus. We conclude that, despite its short half-life, [111In-DTPA-Arg1]-substance P, a new radiopharmaceutical, can be used to visualize the thymus. This may contribute to the investigation of the role of thymus in immune-mediated diseases. In addition, inflammatory sites in various diseases could be visualized.

Adult↗

Body lift.

After weight reduction by means of small intestine bypass, the patients have problems with cutis laxa of abdomen, femora, brachia, and mammae pendens. When all these problems are solved by reduction operations, the skin still does not fit. A new operation, "body lift," to resolve the remaining problem with respect to physiological and neurological segments, has been performed.

Adipose Tissue↗

Histamine in C3H/W mice carrying spontaneous tumors of the mammary gland.

Adenocarcinoma mammae, a spontaneously growing mammary cancer in C3H/W mice, contrary to many transplanted tumors does not evoke any rise in histamine level either in the tumor or in distant tissues. On the other hand, the histamine level is reduced by 90% in the tumor in comparison with the healthy gland. This seems to be a consequence of the fall of histidine decarboxylase activity to below a detectable level. There is also a significant reduction in histamine N-methyltransferase activity to one-fifth of the control level. The healthy mammary gland contains a high concentration of histamine and catabolizes it exclusively through the methylation pathway.

Adenocarcinoma↗

[Telethermographic studies on the effect of immunoglobulins (Beriglobin) on heat radiation behavior in radiodermatitis].

BACKGROUND: Immunoglobulines are supposed to have a soothing effect on the degree of dermatitides and mucositides caused by irradiation. Research so far has been based on empiric information or reports of case studies mostly basing on subjective criteria. This study reports on objective thermographic measuring of heat radiation of dermatitides developing in the course of radiotherapy in case of female patients receiving postoperative radiotherapy after breast preserving operation on mamma carcinoma. Idea behind this is that immunglobulines affect inflammations of skin induced by irradiation, then also one of theses parameters, in this case heat, would be subject to change. PATIENTS AND METHOD: Sixteen patients received 10 ml Beriglobin before first and 5 ml after 5th and 10th radiation (corresponds to 0 Gy, 10 Gy and 20 Gy) as intragluteal injection. Before starting with radiation as well as after 10 Gy respectively applied, upper bodies of patients were examined thermographically until final dose of 50 Gy was reached. Here temperature progress on upper body halves exposed to irradiation was compared with the untreated halves as well as with upper bodies of control group consisting of 20 patients who had received no immunoglobuline injections. RESULTS: Patients who received immunoglobuline injections showed no differences in their skin temperature progress in comparison with the control group (Table 1, Figure 1). Skin temperature at the beginning as well as temperature progress during treatment and temperature at the end of treatment were identical in both groups. Also the relative temperature increase (temperature of body half subject to irradiation minus temperature of the other body half) was identical in both therapy groups (Table 2, Figure 2). CONCLUSION: Immunoglobulines (Beriglobin) do not influence the course of thermal radiation due to dermatitis developing during a series of irradiation treatments. This results in the conclusion, that immunoglobulines do not have any influence in the vasodilative part of dermatitis and vasodilative redness respectively.

Adult↗

Elastic registration of x-ray mammograms and three-dimensional magnetic resonance imaging data.

Major problems in treating breast cancer are the early detection of tumors and accurate biopsy of small volumes of breast (mamma) tissue. This report presents an elastic registration algorithm of two x-ray mammograms and a corresponding magnetic resonance imaging (MRI) volume. To cope with the soft tissue deformation of the breast during mammography, a two-dimensional model of breast deformation behavior is used as an elastic transformation. Normalized mutual information is employed as a measure of similarity. Regions of interest in the uncompressed x-ray mammograms are projected into the MRI volume to determine their three-dimensional origin.

Algorithms↗

[Disease specific stress of tumor patients at the beginning of radiotherapy. Effects on psychosocial support requirement].

PURPOSE: Radiotherapy brings a tumor patient into a special life situation in which different variables play a role of often unknown importance. The goal of this study was to investigate disease specific stress of tumor patients at the beginning of radiotherapy with established psychodiagnostic questionnaires and to evaluate the effect on psychosocial support requirement in order to reduce stress and to improve quality of life and compliance during radiotherapeutical treatment. PATIENTS AND METHODS: 732 patients were screened, of whom 446 (60.9%) fulfilled the criteria for inclusion (refusals 21.0%, low karnorsky performance status 6.6%, management problems 3.4%, language barriers 3.0%, cognitive restrictions 2.6%, death 2.5%). Disease specific aspects of stress in the questionnaire (Fragebogen zur Belastung von Krebspatienten, FBK), life situation (LS) and self-defined care requirements (BB) (Figure 1) were self-rated by patients with different tumor types before radiotherapy. Medical and sociodemographic data were also documented. We investigated 446 patients (262 male, 184 female; median age 60.0 years) with different diagnoses (Table 1). RESULTS: Stress was observed mainly due to reduction of efficiency, anxiety and pain on the subscales (Figure 2). Women had a significant higher stress on subscales of pain (p = 0.016) and anxiety (p = 0.009) (Table 2), patients younger than 45 years in the subscale information (p = 0.002) and patients older than 45 and younger than 60 years in the subscale anxiety (p = 0.002) and the total score (p = 0.003) (Table 3). Patients with mamma carcinoma had the highest the stress (Table 4). The maximum percentages of patients under high stress were found for the subscales of efficiency (43%) and anxiety (40%). The support requirement was characterized by the need of more medical information and dialogue with the doctor. We saw a significant correlation of high stress and high care requirement (Tables 5 and 6). CONCLUSIONS: Psychosocial support should be founded on psychosocial stress diagnostic and self-defined care requirement.

Adult↗

Applications of two-step intensity modulated arc therapy.

PURPOSE: Organs at risk sometimes are surrounded by the target volume. At a first glance it seems to be impossible, to spare the organs at risk, i.e. the spinal cord, without underdosage of parts of the concave target volume. A fast method called "two-step intensity modulated arc therapy" (two-step IMAT) will be shown that avoids underdosage in the target volume near such organs at risk. MATERIALS AND METHODS: Simple rotational techniques reduce the dose to the surrounded organ, however, the blocking of the organ at risk spoils the homogeneity of dose in the target volume in the vicinity of the organ. A further narrow rotation field, tangential to the concave part of the target volume, increases the dose there and homogenizes the dose distribution without deteriorating the dose in the organ at risk significantly. RESULTS: Some cases show that the two-step IMAT and its modifications guarantee a sufficient dose homogeneity in the target volume surrounding an organ at risk. Besides basic theoretical considerations exemplary solutions for head and neck tumors, tumors adjacent to the spinal cord and mamma carcinoma of patients with extremely arched chest are demonstrated. CONCLUSION: Double rotation techniques can provide sufficient dose homogeneity for concave target volumes with excellent sparing of the surrounded organ at risk. They are not time consuming and can be used until IMRT will be applied routinely with adequate time load and effort.

Algorithms↗

[Lymph node tuberculosis as primary manifestation of Hodgkin's disease].

HISTORY AND FINDINGS ON ADMISSION: A 63-year-old female patient was admitted to the authors' hospital for further diagnostic work-up for suspected reactivation of a previously successfully treated lymph node tuberculosis, which had been diagnosed 1 year prior to the current admission. The clinical signs consisted of worsening of the patient's general condition, negacervical lymphadenopathy, night sweats, dyspnea, and superficial inflammation of the right mamma. FINDINGS: A contrast-enhanced CT scan of the neck, thorax and abdomen revealed a generalized enlargement of the cervical, axillar, mediastinal and retroperitoneal lymph nodes, multiple intrapulmonary nodular lesions with a diameter of up to 6 mm, and a substantial right-sided pleural effusion. COURSE OF DISEASE: Under the assumption of reactivation of a lymph node tuberculosis, the patient was initially treated with an extended tuberculostatic therapy. Because of disease progression another lymph node biopsy was performed revealing Hodgkin's disease of mixed-cellularity type with a partly histiocytic necrotizing, partly tuberculoid reaction. The biopsy was negative for acid-fast bacilli. Thereupon initiated chemotherapy according to the ABVD protocol led to a rapid amelioration of the clinical symptoms. CONCLUSION: In the clinical setting of suspected or confirmed lymph node tuberculosis malignant lymphoma should always be considered. This consideration is particular important since Hodgkin's disease is typically associated with a cellular immunosuppression predisposing the subject to tuberculosis.

Antineoplastic Combined Chemotherapy Protocols↗

Evaluation of a laser system for CT software simulation (EXOMIO) in patients with breast cancer.

PURPOSE: To develop a manually movable laser system connected to the CT table for alignment of the isocenter cross of irradiation fields on the patient's skin directly after CT software simulation. MATERIAL AND METHODS: The specially designed laser system was constructed in the authors' department, and the mean focusing accuracy of isocenter translations was analyzed using Alderson phantom measurements. The mean overall accuracy from setup to treatment of the whole procedure of CT software simulation was measured by the comparison of bone structures and mamma contour of the digitally reconstructed radiograph (DRR) with the verification film. The time taken for the different setup procedure steps was evaluated for 70 breast cancer patients who were treated using tangential fields. RESULTS: The mean focusing accuracy of the manually movable laser system after defined isocenter translation was measured as 0.8 +/- 0.5 mm, the mean patient movement on the CT table as 2.0 +/- 1 mm, and the mean positioning accuracy of the first treatment after patient positioning corresponding to the skin alignments as 3.9 +/- 1.5 mm. The time periods for the different steps of the CT software simulation were measured, and the total duration was found to be 35.8 +/- 3.3 min. CONCLUSION: In general, the main advantage of well-known CT software simulation when compared to conventional simulation is the relief of the real X-ray simulator which is feasible with fast planning software (EXOMIO) and the presented movable laser system.

Adult↗

[Congenital familial plaque-shaped glomus tumors. An unusual variant of multiple regional glomus tumors].

Plaque-like glomus tumours are an unusual and very rare clinical form of multiple regional glomus tumours. We report on a 16-year-old girl with this variety of glomus tumours. The irregular angiomatous plaques localized on her back and right hip were present from birth and enlarged with body growth. In addition, there were some bluish nodules scattered on the right mamma, the abdomen and the left shoulder. The family history showed hereditary influences. The proper diagnosis was based on histological and immunohistochemical findings. In the present case report, the clinical, histopathological and immunohistochemical features and the differential diagnosis of multiple plaque-like glomus tumours are discussed.

Adolescent↗

[Normal nasalance for the German language. Nasometric values for clinical use in patients with cleft lip and palate].

OBJECTIVE: Rhinophonia is often present in patients with cleft lip and palate (CLP) many years after palatoplasty. It may be caused either by organic deficits, functional disorders, or both. NasalView is known as an instrument for the objective assessment of nasalance in cases of velopharyngeal insufficiency or incompetence.However,normative values for the German language are not yet available. In order to overcome this problem, this study evaluated such norms using NasalView. METHODS: A total of 50 individuals with normal speech development were examined with NasalView. The median age was 14 years (range 11-20 years). The tone material used comprised the vowels /a:/, /e:/, /i:/, /o:/, /u:/, the sentences S(1): "Die Schokolade ist sehr lecker."("This chocolate is very tasty.") and S(2): "Nenne meine Mamma Mimmi."("Call my mummy Mimmi."), and the text passages of LT(1): "Nordwind und Sonne"("Northwind and sun"), LT(2): "Kindergeburtstag"("A child's birthday party") and LT(3): "Der grosse Gesang"("A famous song"). RESULTS: The mean nasalance for the vowels was 35.9% (+/-8.4), for S(1) (containing no nasal consonants) 24.9% (+/-5.3), and for S(2) 69.6% (+/-5.5) (with many nasal sounds). The results for the text passages were 42.1% (+/-4.2) for LT(1), 36.9% (+/-4.3) for LT(2) and 38.2% (+/-4.4) for LT(3). CONCLUSION: The norms of nasalance for the German language presented here may be useful in measuring the long-term outcome of cleft lip and palate.

Adolescent↗

Protein- and lipid-reactive agents alter outer hair cell lateral membrane motor charge movement.

Outer hair cells from the mamma*lian cochlea are mechanically active cells that rely on charged voltage sensors within their lateral plasma membrane to gate the integral membrane motor protein, prestin, into one of two area states. Here we use protein and lipid reactive reagents to probe the influence of these bilayer components on motor-induced nonlinear membrane capacitance. Of the protein-reactive reagents tested, cross-linking and sulfhydryl reagents were most effective in altering steady state and time-varying motor activity. Of the lipid-altering agents, chloroform and HePC were most effective. Chloroform, in particular, drastically modified the susceptibility of the motor to prior voltage (initial conditions). Our data suggest that outer hair cell motor activity derives substantially from interactions with its lipid environment.

Animals↗

[Atypical Leriche syndrome].

A 73-year old woman presented with mild paraparesis and hypesthesia of the legs. Furthermore, she complained dizziness, fainting and dyspnea. There was a history of peripheral artery disease, diabetes mellitus, arterial hypertension and chronic atrial fibrillation. Five years ago she had breast cancer with removal of the left mamma and additional radiation therapy. Cardiac catheterization at that time demonstrated no significant coronary stenoses. A contrast-enhanced CT-scan excluded lumbal spinal metastases. Instead, a subtotal occlusion of the abdominal aorta was noticed, but was initially interpreted as a chronic thrombosis because there were no typical symptoms and only moderate pain. About 24 hours later the patient developed an acute ischemic syndrome of the legs with progressive paraparesis, cold and pale legs in combination with acidosis and hyperventilation. Color-coded duplex ultrasound showed only a small turbulent flow in the ilial arteries, highly suspicious of a complete occlusion of the distal aorta. Angiography revealed an acute total occlusion of the infrarenal aorta without collaterals. During surgical intervention, complete obstruction of the abdominal aorta above the bifurcation was confirmed. Subsequent embolectomy was performed and an embolus consisting of several layers of different age was extracted. After successful surgical intervention with subsequent clinical improvement, the patient's clinical condition deteriorated a few day later. She died on day 9 after surgery from a complete ischemia of the small intestine and the colon ascendens.

Aged↗

[Dextrocardia and Poland syndrome in a 59-year-old patient].

Poland syndrome consists of unilateral absence of the sternal head of the pectoralis major muscle, ipsilateral symbrachydaktylia, and occasionally associated other malformations of the anterior chest wall, mammilla, and mamma. To our knowledge a simultaneous occurrence with dextrocardia was reported in seven patients. We report on an additional patient with this unusual coincidence. A 59-year old man showed mild symbrachydaktylia of the left hand and deformity of the left part of the anterior chest wall, both present since birth. We found an additional dextrocardia with situs solitus, d-loop, and correctly connected great arteries. Besides arterial hypertension there was no remarkable impairment of the patient's condition.

Dextrocardia↗

Prevalence of bisphosphonate associated osteonecrosis of the jaw within the field of osteonecrosis.

OBJECTIVES: Prevalence of bisphosphonate-associated osteonecrosis of the jaws within the catchment area of a university hospital maxillofacial unit and to review the outcome of treatment. METHODS: In a retrospective study, all patients with osteonecrosis, osteomyelitis and osteoradionecrosis treated in the period from January 2000 to March 2005 in the department for Maxillo Facial Surgery at the University of Mainz, Germany were analysed. RESULTS: Forty percent of the patients are grouped to odontogenic or surgically induced osteomyelitis. The second largest group (28%) were patients with osteoradionecrosis (ORN). Ten percent of all patients developed an osteonecrosis after treatment with bisphosphonates (BOJ). Eight percent showed osteomyelitis or sequester due to a trauma while 14% of all patients had osteomyelitis of unknown origin. All BOJ patients took bisphosphonates because of metastatic diseases of the bone (plasmocytoma, mamma carcinoma and prostate cancer) for up to 5 years. All had been administered a nitrogen-containing bisphosphonate (either pamidronat or zoledronat). Thirteen out of the 17 patients with BOJ and 14 of the 45 with ORN reported a possible trigger like previous tooth extraction, pressure denture sore or periodontal diseases. CONCLUSION: These findings support the association of bisphosphonate therapy and osteonecrosis of the jaw. The importance of this new disease is characterised by the growing number of patients. The role of dental trigger factors and the poor surgical outcome both seem to justify a prophylactic dental care concept in high-risk patients.

Aged↗