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[Prognosis with different therapeutic methods and therapeutic recommendations in operable breast cancers].

Breast carcinoma is the most frequent form of cancer in women. In Switzerland 1265 women died of it in 1975, the mortality rate is rising slowly, the cause of this fact being unclear. There is no uniformity about the best treatment of breast cancer. We analyzed 454 carcinomas, operated in the years 1961--1971 after Halsted, Patey and McWhirter. We found similar 5- and 10-year survival rates with the Halsted and the Patey method of operation, however, decidedly worse results with the simple mastectomy. Nowadays we recommend the modified radical excision of the breast after Patey at all stages; in addition we treat all patients with postoperative X-ray therapy or prescribe an adjuvant cytostatic therapy based on the experimental study of the SAKK (Swiss Therapy Group for Clinical Cancer Research).

Adolescent↗

[Urokinase. Biochemical therapeutical and therapeutical data (author's transl)].

Two thrombolytic agents are mainly used in patients: streptokinase (SK) and urokinase (UK). UK from human origin is an endopeptidase which is able to convert plasminogen into plasmin. UK is only secreted by the kidney and is only found in urine which is presently the only source of extraction. Studies in man have shown that UK produces a highly reproducible state of enhanced plasma thrombolytic activity with a high fibrinolysis/fibrnogenolysis ratio and a lack of toxicity and antigenicity. The half life in Animal is short as well as the duration of fibrinolytic activity in Man. In clinical experience, positive results have been reported in pulminary embolism while the issues in myocardial infarction are controversial. Suggestive results have been registered in deep vein thrombosis, in ophthalmologic field and in desobstruction of arterio-venious shunts. No evident benefit has been noted in cerebral vascular disease. Up to now, UK has been very well tolerated.

Animals↗

[Experimental studies on the optimal therapeutic mode of intra-arterial infusion of 5-fluorouracil. (2) Concentrations within the tumors and normal tissues and therapeutic and adverse effects of 5-fluorouracil delivered by various routes].

5-Fluorouracil levels in Yoshida sarcoma implanted subcutaneously and some organs of rats were measured following intraarterial or intravenous administration of 5-FU at various infusion time and doses, and the relationship between 5-FU level in tumors and antitumor effect was examined. The antitumor effect following intraarterial infusion of 5-FU was superior to its systemic administration. With intraarterial infusion, higher levels of 5-FU in tumors could be expected during infusion and immediately after injection. One-shot intraarterial injection of 5-FU was much more effective than continuous infusion of 5-FU from view points of the antitumor effect. This reason might be attributed to that, 5-FU level in the tumor after one shot intraarterial injection was maintained higher for many longer period than its level during continuous infusion. 5-FU levels in the liver following and during intraaortic infusion of 5-FU showed interesting change, i.e. if 5-FU levels flowing into the liver was low, 5-FU in the liver was not detected at all, however, if high level of 5-FU was flown into, the liver 5-FU was measured even 24 hours after injection. It was supposed that the low level of 5-FU was degraded by the liver easily, but the high level of 5-FU flown into the liver could not be metabolized. From these experiments it may be concluded that infusion time of intraarterial administration of 5-FU must be as short as possible within tolerable toxicity, and infusion doses must be as high as possible that could be degraded by the liver for reduction of toxicity.

Animals↗

[Current therapeutic principles as well as new therapeutic aspects of idiopathic hypertrophic subaortic stenosis. II. Pathophysiology, natural course and diagnosis].

Idiopathic hypertrophic subaortic stenosis is a noncompensatory hypertrophy of the myocardium which above all concerns the ventricular septum in its upper part near to the basis. The etiology is not yet sufficiently clarified, though a genetic component is regarded as ascertained on account of the proved familial accumulations. Haemodynamically the morphologic changes effect a systolic obstruction of the left-ventricular outflow, an insufficiency of the mitral valve and an aggravated diastolic filling of the left ventricle. Further pathophysiological symptoms of the functional subaortic stenosis are an extremely rapid ejection of blood in the early, not obstructive phase of the systole as well as a pathological forward movement of the mitral valve beginning in the midst of the systole. The disease has a bad prognosis. To be sure, the natural course is usually characterized only by a slow progression of the complaints, however, particularly in adolescents frequently sudden cases of death appear by disturbances of the cardiac rhythm or a relative coronary insufficiency. The disease which is already frequently to be diagnosed according to anamnesis, auscultation, ECG and form of the pulse curve may be ascertained using the ultrasound echocardiography as well as heart catheterization including angiography. Apart from a direct measurement of the ventriculo-ventricular pressure gradient during wuch examinations the size of the functional obstruction may further be characterized by certain pharmaca or physical methods which influence the volume of the ventricle or the afterload.

Angiocardiography↗

[A proposal for the amendment of Law No. 644 of 2 December 1975 on Regulation of the removal of parts of cadavers for the purpose of therapeutic transplantation, and rules concerning the removal of the hypophysis from cadavers for the production of extracts for therapeutic use: (Off. Gazz. No. 344, 19 December 1975)].

Law No. 644 on organ transplants is examined in the light of personal experience and the international literature. Reference is made to the non-correspondence of ECG, absence of plantar reflexes, and paralytic mydriasis for the early diagnosis of cerebral death. Stress is laid on the importance of cerebral arteriography, retinal fluorangiography, and evoked potentials in association with clinical criteria.

Cadaver↗

[Serum ferritin levels in patient with gynecological malignancy--especially the judgement of therapeutic response and the monitor during the post-therapeutic follow-up period (author's transl)].

Serum ferritin levels in patients with gynecological malignancy were measured by radioimmunoassay and in addition CEA, AFP and CRP were measured simultaneously. No samples had elevated values more than 200 ng/ml in none malignancy. The serum ferritin levels was elevated (greater than 200 ng/ml) in many patients with advanced cervical cancer and its recurrence, while early stage were almost within normal ferritin range. Patients with ovarian cancer showed normal ferritin levels, but its recurrence showed almost within normal levels than other groups. Serial measurements of serum ferritin showed a fall in patients who responded to radiation therapy or chemotherapy. In patients with tumor progression during therapy, ferritin values increased. The highest ferritin levels were found in patients with the time of recurrence and death. Ferritin levels showed low values in 5 cases of ovarian cancer without symptoms of recurrence on follow-up over 18 months. No correlation was found between ferritin and CEA or AFP levels in different patients except some cases. These results suggest that determination of serum ferritin may be useful to detect recurrence and to monitor the result of treatment.

Adult↗