When are breast cancer patients old enough for the quitclaim of local control?

BACKGROUND: Although postoperative radiotherapy (RT) after breast-conserving surgery (BCS) halves the 10-year recurrence rate in breast cancer patients through all age groups, the question of whether RT may be omitted and replaced by endocrine therapy for women aged 70 years and older with low-risk factors has recently become an issue of debate. METHODS: Survey of the relevant recent literature (Medline) and international guidelines. RESULTS: Three randomized studies investigating the effect of RT in older women revealed significantly increased local recurrence rates when RT was omitted, and a negative impact on disease-free survival was observed in two of these trials. Despite these findings, in one of the studies omission of RT in women over 70 is recommended, leading to a respective amendment in the guidelines of the American National Comprehensive Cancer Network. Several large retrospective cohort studies analyzing the outcome of patients over 65 years with and without RT have since been published and showed a significantly improved local control in all subgroups of advanced age and stage, which predominantly translated into improved disease-free and overall survival. CONCLUSION: No subgroup of elderly patients has yet been identified that did not profit from RT in terms of local control. Therefore, chronological age alone is not an appropriate criterion for deciding against or in favor of adjuvant RT. The DEGRO breast cancer expert panel explicitly discourages determination of a certain age for the omission of postoperative RT in healthy elderly women with low-risk breast cancer. For frail elderly women, treatment decisions should be individually decided on the basis of standardized geriatric assessment.

Functional expression of the Aequorea victoria green fluorescent protein in insect cells using the baculovirus expression system.

A DNA fragment encoding the green fluorescent protein (GFP) was isolated via PCR from a jellyfish Aequorea victoria cDNA, cloned and sequenced. Subsequently, a recombinant baculovirus bearing the coding region of the GFP under the transcriptional control of the Autographa californica nuclear polyhedrosis virus (AcMNPV) polyhedrin gene promoter was constructed and isolated. High-level expression of GFP could be easily monitored in Spodoptera frugiperda (Sf9) insect cells after infection with recombinant baculovirus, due to the intrinsic fluorescence (lambda(max) = 508 nm) of the recombinant protein after excitation with blue light (lambda(max) = 400 nm). The functional recombinant GFP displayed an apparent molecular mass of approximately 43 kDa and the fluorescence emission spectrum of the recombinant protein was virtually identical to that of the native green fluorescent protein.

Original papers: Ocular motility disorders after surgery for retinitis pigmentosa 'Cuba-therapy'.

Since 1988 Cuban ophthalmologists use a combined 'therapy' for retinitis pigmentosa. The treatment, comprising ozonization, electrostimulation, vasodilators, and an unknown surgical procedure after O. Pelaez, is said to stop the progression of the disease. While the nature of the operation remains unclear and scientific proof of its efficacy is still absent, reports about persisting active and passive impairments of ocular motility are becoming more frequent. The authors present the pre-, intra- and postoperative findings in two patients who developed persisting diplopia after Pelaez's operation. In both cases, one with +14° esotropia, the other with up to 25° incyclotropia and bilateral Brown's syndrome, binocular single vision was restored by recession of the medial rectus and superior oblique muscles. Comparing the functional findings before and one year after 'Cuba-therapy', the treatment fails to prevent progressive loss of visual acuity and visual field. Therefore, the Cuban treatment trial should not be recommended in retinitis pigmentosa.

Cloning of a membrane-associated protein which modifies activity and properties of the Na(+)-D-glucose cotransporter.

An expression library from porcine kidney cortex was screened with a monoclonal antibody (R4A6) which stimulates high-affinity phlorizin binding in kidney and intestine but does not react with the membrane protein (SGLT1) which mediates Na(+)-coupled transport of D-glucose (Hediger, M.A., Coady, M.J., Ikeda, T.S., and Wright, E.M. (1987) Nature 330, 379-381). A cDNA (RS1) was obtained which codes for a hydrophilic M(r) 66,832 polypeptide and contains a predicted hydrophobic alpha-helix at the COOH terminus. After expression in Xenopus oocytes RS1 protein was found associated with the plasma membrane. RS1-homologous mRNAs were detected in renal outer cortex and outer medulla, small intestine, liver, and LLCPK1 cells, but not in skeletal muscle, heart muscle, Madin-Darby canine kidney (MDCK) cells, renal inner medulla, and Xenopus oocytes. After nondenaturing gel electrophoresis of renal brush-border membranes comigration of RS1- and SGLT1-homologous proteins as a high molecular weight complex was demonstrated. RS1 altered the expression of Na(+)-glucose cotransport by SGLT1 in Xenopus oocytes. There was no effect on the expression of the nonhomologous transporters for Na(+)-gamma-aminobutyric acid cotransport and for Na(+)-independent glucose transport. However, RS1 also changed the expression of the SGLT1-homologous Na(+)-myo-inositol cotransporter from MDCK cells. The Vmax of methyl-alpha-D-glucopyranoside (AMG) transport expressed after injection of a small amount of SGLT1-cRNA was increased 40-fold when a stoichiometric amount of RS1-cRNA was coinjected. In addition the voltage and glucose dependence of expressed AMG uptake and the concentration dependence of transport inhibition by phlorizin were changed when stoichiometric amounts of RS1-cRNA were coinjected with SGLT1-cRNA. Thus with SGLT1 one apparent transport site (K0.5 about 100 microM) and one apparent phlorizin inhibition site (Ki about 5 microM) was observed whereas with SGLT1 plus RS1 two apparent transport sites (K0.5(1) about 20 microM, K0.5(2) about 1 mM) and two apparent phlorizin inhibition sites (Ki(1) about 0.3 microM, Ki(2) about 30 microM) were found as has been described in brush-border membrane vesicles of kidney and intestine (see e.g. Koepsell, H., Fritzsch, G., Korn, K., and Madrala, A. (1990) J. Membr. Biol. 114, 113-132). The data suggest that the Na(+)-D-glucose cotransporter and possibly also other SGLT1-type Na(+)-cotransporters contain RS1-type regulatory subunits.

[Efficacy and tolerance of Uroflux, a bladder and kidney tea, in the treatment of urinary tract infections, especially in diabetes mellitus]. / Zur Wirksamkeit und Verträglichkeit von Blasen-Nieren-Tee Uroflux bei der Behandlung von Harnwegsinfektionen speziell bei Diabetes mellitus.

In an open study the use of Uroflux tea and sugar coated tablets individually and in combination with chemotherapeutic or antibiotic therapy in 52 patients is described. Urine analysis showed improvement rates of 92 and 93 per cent respectively. A blind trial was carried out separately in diabetic patients over a period of 14 days in order to evaluate the effects on daily blood sugar levels of Uroflux tea against a comparative product. It was clearly shown, that the patients on Uroflux tea showed no changes in daily blood sugar profiles. Contrary to this is was noteworthy that blood sugar concentrations in patients receiving the comparative product were elevated in the morning before breakfast as well as one hour after the midday meal. There were no side effects observed with any of the Uroflux dosage forms; even patients complaining of "sensitive stomach" reported excellent tolerance.

[Therapy of cervico-brachialgia. Controlled clinical comparison of a high-dose combination of neurotropic vitamins with an analgesic]. / Zur Therapie der Zerviko-Brachialgie. Kontrollierter klinischer Vergleich einer hochdosierten Kombination neurotroper Vitamine mit einem Analgetikum

The study revealed that cervicobrachialgias (cervical syndrome) can be effectively treated with high-dosed neurotropic vitamins. This refers in particular to pain caused by pressure on the cervical plexus and paravertebral pain on pressur, Regarding paravertebral pain on pressure, it was possible to prove a significant superiority of the therapy with Neurotrat forte. The duration of therapy in both groups was, however, too short in order to prove a significant improvement regarding the lateral listing of the cervical spine. Both forms of treatment produced similar results in view of an improvement of impaired sensibility, paresthesia and alleviation of pain. In both groups side effects were only occasionally observed.