Does Early Physical Maturity Influence Breast Cancer Risk?

Earlier onset of menarche and tallness in adult women are mainly confirmed as risk markers for breast cancer. Recent disparate case-control studies have reported abdominal-type obesity and higher circulating levels of insulin, testosterone and insulin-like growth factor 1, to be further risk markers for breast cancer. There is evidence that abdominal-type obesity is recognisable in girls even before puberty, and disparate studies have shown it to be correlated with earlier onset of menarche, insulin resistance leading to hyperinsulinaemia, and an abnormal sex steroid profile. The implications are that earlier onset of puberty in a subset of girls can lead to more prolonged exposure of developing breast tissue to an abnormal sex steroid profile and also to a higher circulating level of insulin. It is postulated that these metabolic/endocrine concomitants of abdominal-type obesity could play a role in promoting mammary carcinogenesis at a young age, particularly if genetic predisposition is present.     

Long-term duration of function of ovarian tissue transplants: case reports

These three case reports describe the long-term duration of function of ovarian cortical tissue grafts among patients in a university fertility preservation programme in Europe and in a private practice programme in the USA. One woman underwent sterilizing cancer treatment and had frozen ovarian tissue transplanted, and two women underwent fresh ovarian tissue transplants. The function of ovarian cortical strips has continued for more than 7 years in these three women, with the birth of eight healthy babies following a single graft per patient. In addition to these three cases, transplantation (repeatedly in some cases) of cryopreserved ovarian tissue has restored reproductive function to all other women in the study centres’ programmes for some years. The sustained longevity of function of the transplanted tissue suggests that it may also be possible to postpone the normal time of menopause or to alleviate its symptoms.These three case reports describe the long-term duration of function of ovarian cortical tissue grafts among patients in a university fertility preservation programme in Europe and in a private practice programme in the USA. One woman underwent sterilizing cancer treatment and had frozen ovarian tissue transplanted, and two women underwent fresh ovarian tissue transplants. Function of ovarian cortical strips has continued for more than 7 years in these three women, with the birth of eight healthy babies following a single graft per patient. In addition to these three cases, transplantation (repeatedly in some cases) of cryopreserved ovarian tissue has restored reproductive function to all other women in our programmes for some years. The sustained longevity of function of the transplanted tissue suggests that it may also be possible to postpone the normal time of menopause or to alleviate its symptoms.     

Progesterone binding cyst protein (PBCP) in primary breast cancer: A new prognostic factor?

Summary Different secretory proteins have been evaluated as possible tumor markers in breast cancer. In this study progesterone binding cyst protein (PBCP) has been quantitated in breast tumor tissue. We report on a correlation of PBCP in cytosols of primary breast cancer, with known prognostic factors. A significant difference (p < 0.001, Chi-square) in the frequency of PBCP-negative patients in clinical Stage I and Stage II is found. This was mainly attributed to a difference between T₁ and T₂ tumors, with less contribution from nodal status. A biological function of PBCP in breast cancer is not known. The distribution of PBCP in our patients has a close resemblance with expected number of node positive patients, suggesting that PBCP as a tumor marker may aid in providing prognostic information in breast cancer patients.     

The safety of tocolytics used for the inhibition of preterm labour

ABSTRACT

Introduction: Preterm birth is the major cause of neonatal mortality and morbidity worldwide and a huge cost burden on healthcare. Between 22 and 26 completed weeks of gestation, for every day that delivery is delayed, survival increases by 3%.

Areas covered: Following a systematic review of the literature, we have provided an overview of the use of tocolytics for the prevention of preterm birth and have examined the fetal and maternal adverse effects of the various tocolytic agents currently in use.

Expert opinion: No tocolytic currently in use was developed specifically to treat preterm labour so most have multi-organ side effects. β₂-agonists are relatively safe for the fetus but have rare and potentially serious maternal adverse effects. In contrast, prostaglandin synthetase inhibitors have potentially serious side effects for the fetus and neonate but have mild maternal gastrointestinal side effects. In Europe, the choice of first line therapy is either atosiban or nifedipine. The evidence base for atosiban is much more robust than for nifedipine. While their efficacy is similar, atosiban has placebo level side effects and is safer than nifedipine but is much more expensive.     

Function After Removal of Various Hip and Thigh Muscles for Extirpation of Tumors

Forty-six patients who had undergone excision of one or more well defined hip and/or thigh muscles because of a soft-tissue tumor or a tumoriform lesion were investigated with respect to the function of the operated limb and the isometric and isokinetic strength of the affected motion or motions, relative to the non-operated side (percentage). Hip flexion: Loss of the iliopsoas caused only slight impairment of function. The flexion strength decreased with increasing flexion of the hip joint. Loss of the rectus femoris reduced the isometric strength by 37 and the isokinetic strength by 17 per cent. Hip abduction: The strength reduction was only about 50 per cent and the impairment of function only slight or moderate even in patients with extensive loss of abductor muscles. Hip adduction: Removal of all three prime adductors (longus, brevis, magnus) caused a strength reduction of about 70 per cent but the impairment of function was only slight or moderate. Hip extension: Loss of the gluteus maximus caused only a small strength reduction and no impairment or only slight impairment of function. Significant strength reduction was only seen when all hamstrings had been removed. Knee extension: Loss of one, two, and three of the quadriceps muscles reduced the isometric strength by 22, 33, and 55 per cent, respectively. The isokinetic strength was reduced somewhat more. The strength reduction usually had to exceed 50 per cent to cause more than slight impairment of function. Knee flexion: Loss of the semitendinosus, the biceps femoris, and all the hamstrings reduced the isometric strength by 24, 28, and 67 per cent, respectively. The isokinetic strength was reduced somewhat less. Loss of one of the hamstrings usually caused no impairment of function whereas loss of all three resulted in moderate impairment of function.     

Scapulectomy for malignant tumor: Function and shoulder strength in five patients

Function and muscular strength were studied in five patients who had undergone either total or subtotal scapulectomy for malignant tumor. We found a striking difference in the functional impairment between the two patients with total and the three patients with subtotal scapulectomy. The latter three patients were able to handle light objects with their hands over their heads, and reached or nearly reached the horizontal plane in flexion and abduction of the shoulder. The two patients with total scapulectomy had a flexion and abduction range between 40 and 50 degrees. The mean isometric muscle strength in flexion relative to the non-operated side was 17 and 37 per cent for patients with total and subtotal scapulectomy, respectively, and the abduction strength 14 and 44 per cent, respectively. After scapulectomy, a reasonably good function can be expected, especially if it is possible to preserve the glenoid fossa and/or the acromion.