HER-2/neu (c-erbB-2) evaluation in primary breast carcinoma by fluorescent in situ hybridization and immunohistochemistry with special focus on intratumor heterogeneity and comparison of invasive and in situ components.

We have studied the intratumor HER-2/neu heterogeneity in 78 consecutive and population-based primary invasive breast carcinomas. Within the invasive component, heterogeneity was detected in only 1 of 78 tumors. In 48 tumors (62%), we found both in situ and invasive components in analyzed tissue sections. Twelve of these 48 tumors had a difference of at least 2 arbitrary units in the in situ compared with the invasive part of the tumor with regard to the HER-2/neu status analyzed by HercepTest (immunohistochemistry). Eight of these 12 tumors were reanalyzed with fluorescent in situ hybridization and immunohistochemistry with and without a new Automated Cellular Imaging System. In this limited material, immunohistochemistry in combination with the Automated Cellular Imaging System seemed to have a better correlation with fluorescent in situ hybridization than immunostaining analyzed manually. In conclusion, HER-2/neu expression is not seldom heterogeneous in invasive compared with in situ components within a tumor. This finding should be considered in the choice of evaluation method. To avoid heterogeneity as a confounding factor in HER-2/neu analyses, detection methods such as immunohistochemistry and fluorescent in situ hybridization, which can provide evaluation in a preserved tissue architecture, should be used. Perhaps the intratumor HER-2/neu heterogeneity can explain some of the unexpected failures of trastuzumab therapy.     

Treatment planning in residential institutions

In child and youth care in the Netherlands, systematic planning of treatment is more and more considered to be a condition for effective and well founded treatment. Although workers are convinced of the benefits of treatment plans, treatment planning is not yet a natural and integrated part of residential care. There are several pressure points. In this article a model of treatment planning will be presented that contributes to an answer to these pressure points. The theoretical bases and the practical implications of this model will be discussed.     

Cerebral involvement in children with acute and relapsing inflammatory polyneuropathy

We present two children with seizures and other signs of cerebral involvement at the outset of acute inflammatory demyelinating polyneuropathy, consistent with a diagnosis of encephalomyeloradiculoneuropathy. One child had a recurrence associated with mild central dysfunction and improved during therapy with corticosteroids. Both children recovered completely. Both acute and relapsing inflammatory demyelinating neuropathy may be accompanied by cerebral dysfunction, expanding the clinical spectrum of encephalomyeloradiculoneuropathy.     

'To touch them, is to love them': effects of direct experience with condoms on adolescents' attitudes toward condoms

The present study examined the effect of a short physical interactionwith condoms (opening packages, taking out the condoms and unrollingthem) on the attitude toward condoms and on intended condomuse. Using a pre-post experimental design, 101 adolescents wererandomly assigned to one experimental and four control groups.Subjects in the experimental group handled condoms for about10 min, answering questions about the difficulty of performingthe instructed tasks. In the first control group, subjects completeda filler questionnaire on HIV infection. Subjects in a secondcontrol group watched a peer from the experimental group andanswered similar questions about the difficulty of performingthe tasks. The attention of subjects in the third control groupwas focused away from the features of condoms that are associatedwith their use; subjects were instructed to look at the condomsand complete a filler task. Subjects in a last control groupwere to observe subjects from Control group 3 and to completethe same filler task. Results indicated that having a short,direct experience with condoms failed to influence the attitudetoward condom use and intended condom use. Post hoc examinationof the effects in the control groups, however, suggested thatinducing an affective focus in subjects resulted in positiveattitudinal changes and had a positive effect on the expectationto use condoms in the future.