Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study

Background: The prognostic meaning and thus indication for adjuvanttherapy of lymphogenic micrometastases in breast cancer patientsis still under debate. Patients and methods: From 1999 to 2007, 703 patients with _cT_1–2N₀breast cancer underwent surgery including sentinel lymph nodebiopsy. Examination of sentinel lymph nodes consisted of hematoxylinand eosin and immunohistochemistry staining following serialsectioning of the sentinel node. Patients were divided intofour groups: _pN₀ (n = 423), _pN_1micro (n = 81), _pN_1a (n = 130)and _pN_1b (n = 69). Median follow-up was 40 months. Results: At the end of follow-up, 53 patients had died and 64had recurrent disease. Compared with _pN₀ and following adjustmentfor possible confounders, including adjuvant systemic treatment,overall survival was not significantly different for _pN_1microwhile significantly worse for _pN_1a and _pN_1b {hazard ratio (HR)[95% confidence interval (CI)]: 0.59 [0.14–2.58], 4.31[1.85–10.01], 10.66 [4.04–28.14], respectively}.Likewise, disease-free survival was not significantly differentfor _pN_1micro and worse for _pN_1a and _pN_1b (HR [95% CI]: 1.43[0.67–3.02], 2.79 [1.37–5.66], 7.13 [3.27–15.54],respectively). Distant metastases were more commonly observedin the _pN_1micro than in the _pN₀ group, but still not as commonas in the _pN_1a or _pN_1b group (HR [95% CI]: 4.85 [1.79–13.18],10.34 [3.82–28.00], 23.25 [7.88–68.56], respectively). Conclusion: Although the risk of distant metastases was higherin patients in the _pN_1micro than in the _pN₀ group, no statisticallysignificant differences were observed in overall or disease-freesurvival between _pN₀ and _pN_1micro. Micrometastatic lymph nodeinvolvement in itself should not be an indication for adjuvantchemotherapy in breast cancer patients. Key words: breast cancer, micrometastases, prognosis, sentinel lymph node Received for publication March 11, 2008. Revision received June 25, 2008. Accepted for publication July 1, 2008.     

Medizinische Ausbildung in Bewegung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz -     

Isolation and characterization of 10 polymorphic microsatellite markers for the Ouachita Highlands endemic Notropis suttkusi (Teleostei: Cyprinidae)

Human pressures primarily associated with urbanization, forestry practices, over-mining of groundwater, and reservoir construction threaten the exceptional aquatic endemism of the Ouachita Highlands of southeastern Oklahoma and southwestern Arkansas, USA. At present, there is a need for hypervariable markers useful for understanding population structure and historical demography, thereby helping to provide a framework for conservation efforts. In this paper we describe 10 microsatellite markers for Notropis suttkusi (rocky shiner), a species endemic to the Ouachita Highlands. We characterize these markers on 40 individuals from Blue River in Oklahoma. The loci yielded 3–23 alleles per locus, with mean observed and expected heterozygosites of 0.679 and 0.729, respectively. The availability of these markers will facilitate studies of the conservation genetics of N. suttkusi and should be useful for other members of the Notropis rubellus complex.     

Pilot clinical investigation of risperidone in the treatment of psychotic patients.

Sixty-one adult psychotic patients were treated for four weeks in an open dose-finding study with the new combined serotonin-dopamine antagonist risperidone (R 64 766). Risperidone had a rapid onset of action; a highly significant decrease in the total score on the Brief Psychiatric Rating Scale (BPRS) was already noticed after the first week of treatment. There was also a significant decrease in score for individual BPRS items related to positive, negative, and affective symptoms. In spite of the withdrawal of antiparkinson medication at selection, a significant decrease in extra-pyramidal symptoms (EPS) was observed, as assessed on the Simpson and Angus Scale. The Clinical Global Impression of therapeutic effect was consistent with the BPRS scores, showing a constant improvement throughout the study. The mean daily dose of risperidone at the end of the study was 3.7 mg. Tolerance was excellent and only mild side-effects were reported. Vital signs, ECG-parameters, and laboratory values remained within normal limits. This study demonstrates that risperidone has great potential as an effective and well-tolerated alternative for the treatment of chronically psychotic patients. It has potent antipsychotic effects, a low EPS-inducing profile, and, at the same time, it improves the negative and affective symptoms of schizophrenia.     

Medizin des Alterns und des alten Menschen

Zusammenfassung Inhalte der Altersmedizin wurden bislang im Medizinstudium in Deutschland nur vereinzelt und fakultativ an Universitäten und Medizinischen Hochschulen angeboten. Die reformierte Approbationsordnung enthält als einen neuen Querschnittsbereich die „Medizin des Alterns und des alten Menschen“ obligatorisch im klinischen Studienabschnitt. Verbindliche Lerninhalte liegen für diesen Querschnittsbereich jedoch nicht vor. Dieser Bericht beschreibt deshalb ein neu entwickeltes Curriculum mit seinem Schwerpunkt auf Seminaren in kleinen Gruppen, die ersten Erfahrungen sowie die Ergebnisse der Evaluation des Unterrichts durch Studierende an der Universität Hamburg. Die Ergebnisse belegen eine hohe Akzeptanz von Inhalt und Form des Unterrichts, der von den befragten Studierenden als interessant und lehrreich eingeschätzt wurde.     

Positional cloning of a gene involved in hereditary multiple exostoses

Hereditary multiple exostosis (EXT) is an autosomal dominant condition mainly characterized by the presence of multiple exostoses on the long bones. These exostoses are benign cartilaginous tumors (enchondromata). Three different EXT loci on chromosomes 8q (EXT1), 11p (EXT2) and 19p (EXT3) have been reported, and recently the EXT1 gene was identified by positional cloning. To isolate the EXT2 gene, we constructed a contig of yeast artificial chromosomes (YAC) and P1 clones covering the complete EXT2 candidate region on chromosome 11p11-p12. One of the transcribed sequences isolated from this region corresponds to a novel gene with homology to the EXT1 gene, and harbours inactivating mutations in different patients with hereditary multiple exostoses. This indicates that this gene is the EXT2 gene. EXT2 has an open reading frame encoding 718 amino acids with an overall homology of 30.9% with EXT1, suggesting that a family of related genes might be responsible for the development of EXT.      

Je schwieriger, desto beliebter. Nutzen, didaktische Qualität und Schwierigkeitsgrad des vorklinischen Lehrangebots aus der Sicht von Hamburger Medizinstudenten

This paper reports the results of a retrospective evaluation of the quality of the preclinical undergraduate training by fifth year medical students at Hamburg Medical Faculty in 2001 by means of a standardized survey. The return rate was 88% (N = 150). Students were rather critical about the quality of their preclinical training as a whole. They critisize a decrease in study motivation and express the feeling that the preclincal phase was not very useful for their actual clinical training. They demand a more clinically and patient oriented education, smaller groups and less "cramming". The evaluation results concerning the single disciplines were more favorable for the most important subjects. Especially anatomy, followed by physiology were best rated both with regard to learning benefit and to didactic quality. Most student opinions did not depend on sex, age or examination results. A positive correlation between learning benefit, didactic quality and degree of difficulty was found: contrary to prejudice difficult courses were rated higher with regard to learning benefit and educational quality.     

Analysis of Health Care Costs in Elderly Patients with Multiple Chronic Conditions Using a Finite Mixture of Generalized Linear Models

In this paper we analysed healthcare costs in a sample of elderly patients suffering from multimorbidity. On the one hand, multimorbid individuals consume a disproportionally large share of healthcare resources. On the other hand, the patient specific number and combination of co‐occurring single diseases result in inhomogeneous data leading to biased estimates when using traditional regression techniques. Therefore, we applied a mixture of regressions in order to control for unobserved heterogeneity focussing on the identification of multimorbidity patterns. We used a subsample of N = 1050 patients from a multicentre prospective cohort study of randomly selected multimorbid primary care patients aged 65 to 85 years in Germany (ISRCTN 89818205) who completed a detailed questionnaire on healthcare utilization during the 6‐month period preceding the interview. Disease combinations of 1047 were included. We detected four different groups of patients with regard to total costs. These groups corresponded largely to findings from the epidemiological literature. The effect of the presence of an additional disease on costs differed between groups. Moreover, two diametrically opposed cost trends were detected with respect to the number of co‐occurring diseases. While in one group costs increased with the number of co‐occurring diseases, in a second group cost tended to decrease. Copyright © 2016 John Wiley & Sons, Ltd.