Angiogenesis and lymphangiogenesis are downregulated in primary breast cancer.

BACKGROUND: Angiogenesis and lymphangiogenesis are considered to play key roles in tumour growth, progression and metastasis. However, targeting tumour angiogenesis in clinical trials showed only modest efficacy. We therefore scrutinised the concept of tumour angiogenesis and lymphangiogenesis by analysing the expression of crucial markers involved in these processes in primary breast cancer. METHODS: We analysed the expression of angiogenic, lymphangiogenic or antiangiogenic factors, their respective receptors and specific markers for endothelial and lymphendothelial cells by quantitative real-time RT-PCR in primary breast cancer and compared the expression profiles to non-cancerous, tumour-adjacent tissues and breast tissues from healthy women. RESULTS: We found decreased mRNA amounts of major angiogenic and lymphangiogenic factors in tumour compared to healthy tissues, whereas antiangiogenic factors were upregulated. Concomitantly, angiogenic and lymphangiogenic receptors were downregulated in breast tumours. This antiangiogenic, antilymphangiogenic microenvironment was even more pronounced in aggressive tumours and accompanied by reduced amounts of endothelial and lymphatic endothelial cell markers. CONCLUSION: Primary breast tumours are not a site of highly active angiogenesis and lymphangiogenesis. Selection for tumour cells that survive with minimal vascular supply may account for this observation in clinical apparent tumours.

Multitarget stereotactic core-needle breast biopsy (MSBB)--an effective and safe diagnostic intervention for non-palpable breast lesions: a large prospective single institution study.

Multi-target stereotactic core-needle breast biopsy (MSBB) with large core needles is a modern and effective method to quickly determine the histologic nature of non-palpable breast lesions in an easy ambulatory setting. The number of patients with mammographically detectable, suspicious breast lesions is constantly increasing due to enhanced breast cancer awareness in Western female populations and with expanding screening mammography activities. MSBB is a minimally invasive diagnostic procedure, performed on an ambulatory basis under local anaesthesia in the prone position on a specially constructed stereotactic biopsy table. The patient is able to resume normal activities 1 h after the biopsy procedure. Technical and medical complications are extremely rare. In our study, we analysed the histological results of 426 MSBB procedures in 389 consecutive female patients during the years 1998-2002, and in 91 cases we were able to compare the histologic results of MSBB with the definitive histology of subsequent excisional biopsies. MSBB was technically successful in 415 out of 426 procedures (97.4%). The sensitivity for malignancy was 94.6% (87 out of 92). MSBB, therefore, is to be qualified as a remarkably reliable, patient-friendly and economic diagnostic breast intervention and was well tolerated and highly accepted by virtually all female patients involved in this single-institution feasibility and effectiveness study.

Early hematological toxicity of adjuvant perioperative intraportal and intravenous chemotherapy with fluorouracil, mitomycin and heparin in colorectal cancer. Swiss Group for Clinical Cancer Research.

BACKGROUND: From 1987 to 1993 the Swiss Group for Clinical Cancer Research (SAKK) performed a randomized phase III adjuvant trial in patients with colorectal adenocarcinoma with the objective of comparing intraportal versus intravenous perioperative chemotherapy. PATIENTS AND METHODS: Patients younger than 75 years had a curative en bloc resection of their cancer and were then randomized into three arms: 1. adjuvant perioperative portal liver infusion with fluorouracil, mitomycin and heparin, 2. adjuvant subclavian intravenous infusion with the same regimen and 3. no adjuvant treatment. The hematological toxicity was evaluated by hemoglobin determination and leucocyte and thrombocyte counting before and during ten days after surgery. RESULTS: Hemoglobin showed a median decrease of 22% in the control group. This decrease is aggravated significantly by 3% through the chemotherapy. Leucocytes showed a median decrease of 7% in the control group. Perioperative chemotherapy caused a significantly higher median drop; 23% when given into the liver through the portal vein and 34% when given systemically through a subclavian catheter. Thrombocytes revealed a median decrease of 25% in the control group. Chemotherapy was not associated with a significant additional drop. CONCLUSIONS: Adjuvant perioperative chemotherapy with fluorouracil, mitomycin and Heparin as given in this study is associated with a significant mild drop in hemoglobin and leucocytes during the first 10 postoperative days. If drug dose increases are planned in future trials the addition of hematopoietic growth factors might be considered.

[Limited indications for posterior rectotomy. Results of a series of 42 cases]. / Indications limitées de la rectotomie postérieure. Résultats d'une série de quarante-deux cas.

Forty-two mobile tumours on digital rectal examination were excised by posterior rectotomy: via a transsphincteric approach in 16 cases and via a pararectal suprasphincteric approach in 26 cases; 3 primary protective colostomies were performed. Nineteen tubulovillous adenomas and 23 carcinomas were excised. The excision included the entire thickness of the rectal wall in the form of resection-anastomosis (n = 10) or a disk resection (n = 32). This series consisted of 27 males and 15 females between the ages of 42 and 92 years (mean = 70 years). The definitive histology revealed 12 T1 tumours, 7 T2 tumours and 3 T3 tumours. There were two postoperative deaths. The remaining patients have a mean postoperative follow-up of 45 months. 2/16 (12.5%) local recurrences occurred in the group of tubulovillous adenomas and 2 local recurrences with distant metastases were observed in the carcinoma group, while 3 patients only developed distant metastases. The cancer-related mortality was 5/21 (23.89%). Disturbances of continence persisted in 6/29 surviving patients, 4 patients complained of urgent defecation, 1 of uncontrolled passage of gas and a single patient had persistent incontinence of liquid stools. Posterior rectotomy allows excision of extensive tubulovillous adenomas and local recurrences are less frequent than after transanal excision and are similar to the results obtained with transabdominal rectal resections. The operative mortality was lower than that of laparotomy. Posterior rectotomy allows adequate resection of localised carcinomas (T1) with no lymph node involvement. The statistical frequency of lymph node metastases in stage T2 and T3 tumours only justifies the use of this technique when the patient refuse colostomy, has an excessively high risk to undergo laparotomy or when the operation is purely designed to be palliative. The disturbances of continence observed were minor and only slightly disabling.

[Tubulo-villous adenoma of the duodenum: case report and review of the literature]. / Tubulo-villöses Adenom des Duodenums: Fallvorstellung und Literaturübersicht.

In the literature only 123 cases of tubulovillous adenoma of the duodenum have so far been reported. This rare tumor can be readily diagnosed by endoscopy or hypotonic duodenography. Complete surgical or endoscopic removal is necessary in view of cancerous degeneration in 53% of cases. Depending on the localization, extension and size of the tumor, duodenal segment resection, duodenotomy and submucosal excision or duodenopancreatectomy is the best surgical procedure.

[The treatment of an embolized central venous catheter]. / Die Behandlung embolisierter zentralvenöser Katheter.

The frequent use of central venous catheters for pressure monitoring or long-term administration of fluids can in rare cases lead to embolization of catheter fragments. In view of the potential complications, extractions, extraction is mandatory. The fragments may be removed by use of a loop snare, a helical basket or a myocardial biopsy catheter. The specific approach is described.

[Results of fundoplication in reflux esophagitis]. / Résultats de la fundoplication dans l'oesophagite par reflux.

A retrospective study of 71 patients treated with Nissen-Rossetti fundoplication for a symptomatic esophagitis shows that 82% of the patients are satisfied and symptom-free 2 1/2 years after surgery. 18% have recurrent reflux disease, 15% need medicamentous therapy to control their symptoms, 3% were reoperated on. Possible explantation for recurrent reflux disease are wrap dislocation and wrap disrupture. With one exception recurrences occurred within the first 12 months after operation.

[Transfusion use in curatively operated patients with colorectal carcinomas. Swiss Study Group for Clinical Cancer Research]. / Transfusionsverhalten bei kurativ operierten Patienten mit kolorektalen Karzinomen. Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung (SAKK).

OBJECTIVE: Is there an improvement of the behaviour for restrective blood transfusions after the data in the literature and especially the preliminary data of the SAKK 40/81 study have been published? They have shown a worsening of the prognosis in patients with colorectal cancer after pre-/postoperative blood transfusions have been given. MATERIAL AND METHODS: Analysis of the retrospective transfusion data of the SAKK 40/81 study in comparison with the prospective transfusion data of the study SAKK 40/87. RESULTS: The analysis of the data showed that in the SAKK 40/81 study more patients received blood transfusions than in the SAKK 40/87 study (77% versus 49%). Especially there was a diminution from 90% in the SAKK 40/81 to 59% in the SAKK 40/87 study for the rectal cancer patients respectively from 70% to 44% in the colon cancer patients having received blood transfusions. The mean value of hemoglobin of the patients not having received transfusions has decreased from 11.2 (7.8-15) g/100 ml in the SAKK 40/81 to 10.6 (5.4-15) g/100 ml in the SAKK 40/87 study (p = 0.0001). CONCLUSION: The data of the two SAKK studies showed that in Switzerland the donation of blood transfusions in patients with colorectal cancer has continuously been handled more and more restrictive. An even more restrective use may be possible in future due to new operation techniques and the possibility of preoperative administration of erythropoetin to increase the hemoglobin level.

[Local treatment of breast carcinoma: when is breast-saving therapy not indicated?]. / Lokale Behandlung des Mamma-Karzinoms: Wann ist eine brusterhaltende Therapie nicht geeignet?

Conservative treatment of breast cancer is now an accepted oncological procedure. It further allows a good functional and cosmetic result. This treatment needs more skills and time than mastectomy, as it does not only include a surgical excision but also a postoperative local radiotherapy and a sometimes difficult follow-up during many years. The contraindications for conservative breast cancer therapy are numerous and depend on factors as tumor, patient and radiotherapy. As more than 1100 patients have been treated since 1977 in our area at a single radiooncological center by a breast conserving procedure. We have confirmed or defined criteria which lead to a good local tumor control as well as to good functional and cosmetic results.

[Breast preserving therapy of breast carcinoma: analysis of over 1,300 patients treated in the Basel region]. / Brusterhaltende Therapie beim Mamma-Karzinom: Analyse bei über 1300 in der Region Basel behandelten Patientinnen.

From 1977 to 1994 a total of 1329 breast cancer patients have been treated with breast conserving surgery in the region of Basel. This analysis is based on 832 patients treated from 1977 to 1990 according to a prospective treatment protocol, which was adjusted only once (1985). In comparison with the most known international publications this analysis represents one of the greatest homogeneous series of breast conserving treatment. We observe an overall 5-year survival of 91% and a 10-year survival rate of 77%. 94% of the women remain locally recurrence free at 5 years and 86% at 10 years respectively. At 5 years, freedom of local recurrence totals to 97% in patients without (pN0) and to 89% in patients with tumor involvement of the axillary lymph nodes (pN+) (p = 0.00008), as well as to 96% for pT1 and 91% for pT2-tumors (p = 0.08328). In our analysis the R0-resection significantly influences local recurrence free survival.