Natural course of node-negative breast cancer: high risk-related subgroups.

This study attempted to evaluate the first-generation prognostic factors in terms of relapse-free interval in 297 node-negative breast cancer patients treated with locoregional therapy alone. Predictors of outcome were, in order of strength: tumor size (RR 2.09), tumor grade (RR 2.03) and age (RR 0.97). Age was a single independent prognostic parameter in premenopausal patients younger than 45 (RR 0.82). Tumor size was also a single independent prognostic parameter in middle-aged patients (RR 2.05). In older patients, aged 60 and over, tumor grade (RR 11.6) and type (RR 0,52) in addition to tumor size (RR 7.00) were independent prognostic parameters. Our study of disease-free survival identified high risk-related subgroups: patients younger than 35, middle-aged post-menopausal patients bearing pT2 carcinoma with steroid receptor content lower than 5 fmol/mg, and patients older than 59 bearing pT2 carcinoma with grade 11 and unfavorable types-ductal, lobular.

Natural history of estrogen receptor-negative, progesterone receptor-positive breast cancer.

The biological significance of estrogen receptor-negative but progesterone receptor-positive breast carcinomas is not clear. In the present study the aggressiveness of breast carcinomas in relation to ER and PgR status has been investigated. The probability of disease-free survival in 297 node-negative breast carcinoma patients was monitored during a follow-up ranging from six to 96 months (median 45 months). Steroid hormone receptor content was assayed with the biochemical method recommended by the EORTC. The probability of disease-free survival was significantly worse for patients with ER-negative, PgR-positive carcinomas compared to the other three steroid hormone receptor phenotypes. Our results suggest that ER-negative, PgR-positive breast carcinomas are biologically different in terms of aggressiveness from the other steroid hormone receptor phenotypes.

Expression of epidermal growth factor receptor in breast cancer, from early stages to advanced disease.

Epidermal growth factor receptor was determined in 106 newly diagnosed breast cancer patients, using the biochemical method. The group consisted of 58 patients in stage I-II, and 48 patients in stage III-IV. Although a significant inverse correlation was found between EGF-R status, and ER or PR status, quantitative content of EGF-R did not correlate either with quantitative ER, or PR levels. The ER/PR content was similar in all clinical stages, suggesting their stability during the clinical course of the disease. EGF-R content was significantly higher in stage IV, compared to stage I, while intermediate clinical stages and all substages did not differ according to the EGF-R content. EGF-R was confirmed as a weak prognostic factor within clinical stages. However, in a whole group, the overall survival was significantly better in patients whose tumors EGF-R content was lower than 26 fmol/mg, compared to those with higher ERF-R content. EGF-R content was highly predictive for the response to systemic endocrine treatment, in metastatic breast cancer patients. In locally advanced breast cancer a trend towards higher levels of EGF-R was found in inflammatory breast cancers, compared to non-inflammatory ones. Slightly higher levels were found in responders to local non-endocrine primary treatments (radiotherapy with or without chemotherapy), compared to non-responders, suggesting the possible predictive role of EGF-R for the response to such treatments. Our results emphasized the usefulness of quantitative receptor determination suggesting the relative stability of EGF-R content during the clinical course of breast cancer, its independence from ER, its significant predictive and weak prognostic values, and a possible correlation with the aggressiveness of the disease, and response to non-endocrine treatments.

[Prevention of rheumatic heart defects]. / Preventiva reumatskih srcanih mana.

The study concerned the effect of incomplete or omitted secondary prophylaxis on the onset of rheumatic heart disease as well as the effect of organized secondary prophylaxis on prevention of their Appearance. Of 142 patients with rheumatic heart disease as a result of previous rheumatic fever 39 (27.5%) were on incomplete secondary prophylaxis during one year and 103 (72.5%) had no prophylaxis. As consequence of incomplete or omitted prophylaxis recurrence of rheumatic fever appeared in a high percentage (30.7 of incomplete secondary prophylaxis and 63.1% of omitted prophylaxis). Incomplete and omitted prophylaxis with frequent rheumatic fever recurrence were the main cause of the onset of rheumatic heart disease and invalidism of the Ist IInd degree. On the contrary, during organized secondary prophylaxis the following results were obtained in 224 patients with rheumatic fever (with the average follow-up of 5.8 years): no recurrence of rheumatic fever was registered in patients on regular prophylaxis; in patients on irregular prophylaxis recurrence was noted in 12.2% of patients. In 8 subjects who refused secondary prophylaxis recurrence was established was established in 50% of cases. Of 224 patients with the Ist attack of rheumatic fever during organized secondary prophylaxis rheumatic heart disease were found in 5.35% of patients and in 10% of individuals with rheumatic fever and carditis (112 cases). The organized secondary prophylaxis, introduced in Serbia in 1974, is a reliable and tested procedure in the prevention and gradual eradication of rheumatic heart disease.

[Reactive Yersinia arthritis]. / Reaktivni jersinija artritis.

Yersinia enterocolitica is the cause of acute enteritis in 2 to 3 per cent of cases. In adults it can be a "trigger" of reactive arthritis. Reactive arthritis is characterised by the appearance of sterile arthritis immediately after or during the infection outside the locomotor apparatus. Antibodies for 03 serotype were examined in Yersinia serum in hospitalized patients with the clinical picture of reactive arthritis, because Yersinia, as an intestinal infection provoked by this serotype, is usually the "trigger" of Yersinia reactive arthritis. The antibody titre of 1/160 was found in 33.7 per cent of examined 70 patients, and in 5.8 per cent of that in the control group. Clinical manifestations of reactive arthritis in the group of patients with Yersinia positive antibodies were examined. They were compared with group of patients with Yersinia negative antibodies in the serum.

[The Jones diagnostic criteria for rheumatic fever]. / Jonesovi dijagnozni kriterijumi u reumatskoj groznici.

The apparent fall of rheumatic fever incidence in developed countries and in Yugoslavia is one of the reasons of negligence of the diagnosis of this disease. This fall was associated with mild forms of rheumatic fever (arthritis and mild forms of carditis are the main manifestations) where the beginning resembled other rheumatic disease. Consequently the problem of diagnosis of rheumatic fever is complicated. The early diagnosis of rheumatic fever is very important for the course of the disease, because appropriate measures (secondary prophylaxis) can prevent recurrence and severe rheumatic heart defects. The other disease recent increase of rheumatic fever incidence in the United States is the warning to other countries.