The optimal extent of resection for patients with stages I or II breast cancer treated with conservative surgery and radiotherapy.

The optimal extent of breast resection before irradiation for treatment of early breast cancer has not been defined. Increasing the size of the resection may decrease the risk of local recurrence but will also have an adverse impact on the cosmetic outcome. The 5-year likelihood of a recurrence of the tumor was analyzed in relation to the volume of resected breast tissue in 507 patients with infiltrating ductal carcinoma treated with conservative surgery and radiation therapy between 1968 and 1982. Patients were stratified by clinical T-stage and for each T-stage patients were divided into three groups of equal numbers based on the volume of excised tissue. All patients had at least a gross excision of the tumor and the extent of breast resection was determined at the discretion of the surgeon without knowledge of the histologic features of the tumor. The median follow-up time was 100 months. The 5-year actuarial recurrence rates were analyzed in relation to clinical T-stage (T1 or T2) and the presence or absence of an extensive intraductal component (EIC+ or EIC-). For patients with EIC+ tumors, the largest resections were associated with a substantially lower risk of recurrence in the breast than the smallest resections. This effect was seen both for T1 tumors (10% versus 29%, p = 0.07) and for T2 tumors (9% versus 36%, p = 0.04). For patients with EIC-tumors, recurrence rates were significantly lower than for EIC+ tumors and were not influenced by the volume of resection to the same degree as EIC+ tumors. In the absence of an EIC, recurrence rates for the largest and smallest resections were 0% and 9% (p = 0.02) for T1 tumors and 3% and 6% (p = NS) for T2 tumors. It is concluded that a limited breast resection is acceptable for an EIC- tumor but that a more extensive resection is required for an EIC+ tumor. These results stress the importance of assessing the presence or absence of an EIC in determining the optimal extent of breast resection required before radiation therapy.     

The electrophysiological properties of substantia nigra pars compacta neurones recorded from 6-hydroxydopamine lesioned guinea-pigs in vitro

Summary Intracellular recordings were made from substantia nigra pars compacta neurones in vitro from animals with partial unilateral 6-hydroxydopamine lesions of the nigrostriatal tract. Lesions were assessed and grouped according to the severity of the strital dopamine depletion. No differences were seen between neurones from control and lesioned side nigrae as regards their membrane properties, firing rates, burst activity or percentage of quiescent neurones in any of the lesioned categories. It is concluded that following partial lesioning, the remaining substantia nigra zona compacta neurones in vitro, are functioning normally.     

Carrier diagnosis of Duchenne muscular dystrophy using restriction fragment length polymorphisms

Molecular probes that are tightly linked to and flank the Duchenne muscular dystrophy (DMD) locus, have been used to characterize DMD mutations and diagnose female carriers. Deletions within the Xp21 region were identified for 8 of 71 families studied. Using both DNA and CK studies, accurate (96 to 98%) carrier or noncarrier diagnoses were made for 51 of 75 females at risk in 24 families with a single affected male. DNA studies resulted in an alteration of predicted risk in 40% of the cases. Recombinant diagnostic methods are useful for carrier detection in families with one or more affected males.     

Leitbild für die Leitstelle — Gefahren im Einsatz — Notfallmedizin im DRG-Zeitalter

Zusammenfassung Die 20. notfallmedizinische Jahrestagung der Arbeitsgemeinschaft Südwestdeutscher Notärzte (agswn) behandelte auch in diesem Jahr aktuelle berufspolitische Themen. Aktuelle Entwicklungen zur Verbesserung der Arbeitsabläufe in den Leitstellen wurden dargestellt, EDV-gestützte Systeme zur Notrufabfrage, die Vernetzung der Leitstellen und technische Verbesserungen der Leitstellensysteme genannt. Die Gefahren im Rettungsdienst waren ein weiterer Schwerpunkt der Tagung. Eine Ansteckungsgefahr bei Infektionstransporten bei MRSA-Patienten ist bei sachgemäßem Verhalten nicht zu befürchten. Weiterhin wurden die Möglichkeiten des terroristischen Einsatzes von biologischen Waffen realistisch deutlich relativiert. Amoklagen stellen dagegen eine nur schwer kalkulierbare Gefahrensituation dar. Als 3. Themenschwerpunkt wurden die besonderen Herausforderungen der Notfallmedizin im DRG-Zeitalter umrissen. Die Änderung des Einsatzspektrums und die Reduktion von Notarztstandorten erfordert die Bildung von Kompetenzzentren und eine hohe Qualifikation der Notärzte.     

Innovative Sonographie beim Prostatakarzinom

Zusammenfassung Zur Früherkennung und Stadieneinteilung des Prostatakarzinoms wird heutzutage fast ausschließlich die sog. systematische Mehrfachbiopsie eingesetzt. Hierbei tritt das bildgebende Verfahren – der transrektale Ultraschall – als Diagnostikum mehr und mehr in den Hintergrund und dient fast ausschließlich zur Führung der Biopsienadel in spezifische anatomische Regionen. Doch selbst bei multiplen systematischen Biopsien wird eine hohe Zahl klinisch signifikanter Karzinome übersehen. Diese Tatsache hat zu einer drastischen Steigerung der Anzahl von Gewebeproben geführt. So finden sich Zentren, in denen 6, 10, 12, ja bis zu 143 Gewebeproben in einer Sitzung entnommen werden. Diese immer invasivere heterogene Vorgehensweise bestätigt den Bedarf an Verbesserung in der Ultraschalldiagnostik. Neue und innovative bildgebende Verfahren in der Prostatasonographie werden vorgestellt mit dem Ziel, die diagnostische Aussagekraft bei Erstdiagnose sowie in der Stadienvorhersage zu verbessern. Eine verbesserte Bildgebung bei Diagnosestellung und in der Stadieneinteilung würde zu einer erheblichen Verbesserung bei den Therapieentscheidungen führen.Dieser Beitrag ist dem kürzlich verstorbenen Pathologen J. E. McNeal gewidmet, der die zonale Anatomie der Prostata erstbeschrieben hat.     

Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a Veterans Affairs Cooperative Studies Program Substudy.

OBJECTIVES: The purpose of this study was to determine quality of life (QOL) and exercise performance (EP) in patients with persistent atrial fibrillation (AF) converted to sinus rhythm (SR) compared with those remaining in or reverting to AF. BACKGROUND: Restoration of SR in patients with AF improving QOL and EP remains controversial. METHODS: Patients with persistent AF were randomized double-blind to amiodarone, sotalol, or placebo. Those not achieving SR at day 28 were cardioverted and classified into SR or AF groups at 8 weeks (n = 624) and 1 year (n = 556). The QOL (SF-36), symptom checklist (SCL), specific activity scale (SAS), AF severity scale (AFSS), and EP were assessed. RESULTS: Favorable changes were seen in SR patients at 8 weeks in physical functioning (p < 0.001), physical role limitations (p = 0.03), general health (p = 0.002), and vitality (p < 0.001), and at 1 year in general health (p = 0.007) and social functioning (p = 0.02). Changes in the scores for SCL severity (p = 0.01), functional capacity (p = 0.003), and AFSS symptom burden (p < 0.001) at 8 weeks and in SCL severity (p < 0.01) and AF symptom burden (p < 0.001) at 1 year showed significant improvements in SR versus AF. Symptomatic patients were more likely to have improvement. The EP in SR versus AF was greater from baseline to 8 weeks (p = 0.01) and to 1 year (p = 0.02). The EP correlated with physical functioning and functional capacity except in the AF group at 1 year. CONCLUSIONS: In patients with persistent AF, restoration and maintenance of SR was associated with improvements in QOL measures and EP. There was a strong correlation between QOL measures and EP.     

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