[Diagnostic mode and tumor staging of breast cancers in the setting of opportunistic screenings]. / Diagnoseform und Tumorstadien von Mammakarzinomen unter Bedingungen des opportunistischen Screenings.

PURPOSE: To analyze data at the time of diagnosis of breast cancer in three radiology practices in Austria in the setting of opportunistic screening. MATERIALS AND METHODS: In 529 women (ages 31 - 89, mean age 61.1) with breast cancer, the mode of diagnosis (detected clinically or by opportunistic screening), the local tumor stages, and intervals between screening examinations were assessed. RESULTS: In 33.6 % (178 of 529) of the cases, the breast cancer was detected clinically, and in 66.4 % (351 of 529) of the cases, the cancer was detected by opportunistic screening. Cancers in prognostically favorable stages (in situ carcinomas, pT1 a, pT1 b, pT1c) were detected by opportunistic screening in 79.9 % of the cases. The clinically detected cancers were in locally advanced stages (pT2, pT3) in 58.4 % of the cases. In the majority of clinically detected cases (75 %), the women had never had a mammogram before or had not had a recent one. In 13 % of the cases detected by opportunistic screening, diagnosis was made during the first exam, in 40 % of the cases, the period since the last mammogram was less than 24 months, and in 47 % of the cases, this period was greater than 24 months. CONCLUSION: In our patients the majority of breast cancers were detected in early stages by opportunistic screening. The use of an organized system with exams at regular intervals may further reduce the number of advanced cancers.

[Ultrasound follow-up of palpable solid, probably benign breast lesions (BI-RADS category III)]. / Sonographische Verlaufskontrollen bei palpablen soliden, wahrscheinlich gutartigen Brustläsionen (BI-RADS Kategorie III).

PURPOSE: To determine whether palpable non-calcified solid breast masses with benign morphology on ultrasound can be classified as probably benign and whether these lesions fulfill the criteria required for BI-RADS (TM) category III. MATERIALS AND METHODS: This analysis includes 78 patients with 80 palpable non-calcified solid masses that were classified as probably benign at initial sonography. Of 78 patients, 66 had periodic imaging surveillance (2 - 8 years, mean 4.6 years). The remaining 12 patients had a biopsy after initial imaging. RESULTS: In the 64 patients under surveillance, palpable lesions remained stable at follow-up. In 2 patients lesions increased in size during follow-up and no malignancy was diagnosed at subsequent open biopsy. In 19 of the 66 patients, 29 additional nonpalpable lesions of similar morphology were detected on ultrasound. No malignancy was diagnosed in the 12 patients, who had a biopsy after initial imaging. CONCLUSION: Our data suggest that palpable non-calcified solid breast masses with benign morphology on ultrasound can be classified as probably benign (BI-RADS (TM) category III). Biopsy can be averted when lesions remain stable at follow-up.

'Safe prescribing' ('Sicherer verordnen')-information on drug safety for German physicians.

Actual information on drug safety should be a major concern for physicians. In 1993 a series of drug safety information was established and published by the chamber of physicians of Nordrhein. This information is developed for all practising physicians providing short, actual and independent information on drug safety. An overview of this series which is available for over 80,000 german physicians will be described.

Database of adverse events occurring in clinical studies--useful and necessary?

Due to an amendment of the German Drug Act ethic committees must be informed of all serious or unexpected adverse events occurring during a clinical study. This means that ethic committees may have to reevaluate their recommendations. A database is presented in order to help an ethic committee in decision making. Preliminary results indicate that this database may be helpful in future and-additionally-may be the beginning of pharmacovigilance.

Understanding medication-related needs of low-literacy patients.

An important thrust in preparing pharmacy students to provide pharmaceutical care is acquiring sensitivity to the unique medication-related needs of at-risk patient populations. Low literacy, which affects 21% to 23% of the American population, defines one such population. In collaboration with the Lafayette Adult Reading Academy (LARA), the authors developed an evolving project to increase pharmacy studies' understanding of the medication-related needs and perspectives of low-literacy patients. This was accomplished through a relation-building, three-step oral interview process. The interviewers asked open-ended questions to assess each patient's medication use habits and perspectives. The interview sensitized the pharmacy students to the needs of low-literacy patients for pharmaceutical care. The principal finding was that a caring relationship between pharmacists and patients is prerequisite to patients' openness to share and receive advice about problems and misconceptions associated with their medication use experiences.

Investigation into the combined effects of ethanol and cadmium on rat liver and kidneys.

To examine the combined hepatotoxic and nephrotoxic effects of cadmium and ethanol, rats maintained on an ethanol containing liquid diet (5% w/w) were given cadmium either acutely (3 x 1 mg/kg IP) or subacutely (about 14 mg/kg/day PO for 6 weeks). Parameters tested were cadmium, zinc and copper contents of blood and various organs, metallothionein (MT) contents, polysome profile of liver and kidneys, serum SDH and GPT levels and creatinine clearance. Ethanol reduced the hepatic MT contents without altering the polysome profile and the zinc and copper contents. Cadmium on the other hand raised the MT contents in liver and kidneys. This effect of cadmium predominated in the combined treatment. Morphological examination and functional tests (SDH, GPT, creatinine clearance) indicate that cadmium does not enhance the toxic effects of ethanol, and vice versa.

The influence of tetracyclines on the aggregation of free and membrane-bound polysomes and on the RNA content of the liver of mice.

Tetracycline (100 micrograms/g) and, to a lesser extent, doxycycline (50 and 100 micrograms/g) inhibited the aggregation of free but not of membrane-bound polysomes in the livers of female NMRI mice. In addition tetracycline decreased the RNA content of the fraction of membrane-bound polysomes probably due to detachment from their membrane sites.

[Spontaneous splenic rupture in infectious mononucleosis--organ-sparing operation using fibrin glue]. / Spontane Milzruptur bei infektiöser Mononucleose--Organerhaltende Operation mittels Fibrinklebung.

We present the case of a 16-year-old female patient with infectious mononucleosis complicated by spontaneous splenic rupture on the eighth day of the disease. This event is seldom; only 38 cases of true spontaneous rupture of the spleen in infectious mononucleosis could be found when the literature was reviewed. The diagnosis of splenic rupture in our case was made by ultrasound, just as the further postoperative follow-up. For the first time the splenic lesion was successfully managed by application of fibrin tissue adhesive.

[Adverse effects of antihistaminics]. / Unerwünschte Wirkungen von Antihistaminika.

Of most antihistamines more or less pronounced sedative effects are known. In recently developed substances this effect is said to be less or absent. After some days of application the sedative effect may decrease, but it can be enhanced by simultaneous intake of psychotropic drugs, sedatives or alcohol. There are important interindividual differences. The Drug Commission of the German Medical Profession (AKdA) received reports concerning tiredness, somnolence (even with new antihistamines), CNS-stimulation, nervousness, insomnia and paroniria have also been observed. Furthermore cases of dyskinesia have been reported, which are already described in the literature after long term intake, as well as anticholinergic reactions. Despite of their use as antiallergic drugs, reports on hypersensitivity reactions due to antihistamines, up to anaphylactic reaction have been not infrequently received by the AKdA. In rare cases disturbances of blood cell formation have been reported besides observations of gastrointestinal disorders, increase of appetite and weight. Abuse of antihistamine containing drugs was reported mainly for combinations with psychotropic agents.

The effect of long-term ethanol treatment on a metal binding protein fraction in liver and kidneys of mice.

In mice 4-12 weeks ingestion of ethanol decreased the concentration of a metallothionein-like protein fraction in the liver but not in the kidneys. The zinc and copper concentration also tended to decrease in the liver and remained unaffected in the kidneys.