The impact of chemotherapy for breast cancer on sexual function and health-related quality of life.

PURPOSE: In this prospective trial, we evaluated the influence of chemotherapy for breast cancer on women's health-related quality of life (HR-QoL), sexual function, and mental status. METHODS: The patients completed validated questionnaires on HR-QoL, sexual function, and depression before, during, and at the end and finally 6 months after chemotherapy. Special attention was paid to possible differences between pre- and postmenopausal patients. RESULTS: Between 2008 and 2012, 79 patients were enrolled in the trial (mean age 47.46 years). Premenopausal participants were 63.3 %. Sexual activity dropped from 71.9 % before chemotherapy to a minimum of 47 % at the end of chemotherapy. A similar effect was seen for pleasure and discomfort. Depression values were the highest at the beginning of chemotherapy, with spontaneous improvement in many patients during the course of time. HR-QoL and global health status both increased 6 months after therapy. For almost all parameters, changes were more obvious in pre- than in postmenopausal patients. CONCLUSIONS: In a close monitoring, we observed significant changes in HR-QoL, depression, and sexual function in breast cancer patients. Special attention needs to be paid to premenopausal patients. The knowledge of effective recovery and spontaneous improvement of HR-QoL in spite of still impaired sexuality are important information in counseling both pre- and postmenopausal patients with diagnosis of breast cancer prior to upcoming therapy.

[Idiopathic facial palsy during pregnancy]. / Periphere Fazialisparese in der Schwangerschaft.

BACKGROUND: Idiopathic facial (Bell's) palsy occurring during pregnancy or post partum is a rare disease. Reports regarding incidence, prognosis and associated risk factors are still inconsistent. MATERIAL AND METHODS: We performed a retrospective analysis of patients presenting with idiopathic facial palsy who had been treated in cooperation between obstetric and otorhinolaryngological departments (tertiary referral centers). The time of onset of paralysis, grading according to House and Brackman, treatment modalities and results were analyzed for the years 1999-2010. RESULTS: The incidence of Bell's palsy in pregnancy was 56 in 100,000 live births. Preeclampsia was reported in one case only. Therapy included prednisolone, methylprednisolone and/or pentoxifylline (up to 2005). All results were favorable (House-Brackman 1-2). CONCLUSION: The incidence of Bell's palsy in pregnancy within our cohort is not increased with regard to the international reports. Early treatment with corticosteroids in consultation with the treating obstetrician is indicated in both pregnant and post-partum patients to achieve optimal results.

Video sequence compared to conventional freeze image documentation: a way to improve the sonographic assessment of breast lesions?

PURPOSE: To compare video sequence and conventional freeze image documentation of breast ultrasound findings with respect to lesion assessment and the diagnostic power of established ultrasound characteristics. MATERIALS AND METHODS: Digitally stored freeze images and corresponding video sequences of 50 breast lesions were randomly arranged and interpreted by eight investigators with breast ultrasound training and experience. Established ultrasound criteria were documented on a standardized classification form for every lesion. The investigators were blinded to the clinical and radiological findings, patient characteristics including age, and lesion histology. Statistical analysis compared both groups and correlated the results with the lesion histology. A receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic performance of ultrasound criteria in lesions documented by video sequences compared to freeze images. RESULTS: Breast lesions were assessed almost identically in video sequences and freeze images. Only the features echogenic halo, orientation, and margin varied among both groups. The dynamic features compressibility and mobility were highly statistically significant correlated with the lesion histology in the video sequence interpretation (p < 0.0001). ROC analysis revealed almost identical diagnostic accuracy in both groups (area under the curve 0.719 for video sequences and 0.762 for freeze images). CONCLUSION: Video sequences are an appropriate tool to document lesions in breast ultrasound. In contrast to our hypothesis, however, this tool did not improve the diagnostic power of established ultrasound characteristics compared to freeze image documentation.

Ultrasound characteristics of breast fibroadenomas are related to clinical and histological parameters.

PURPOSE: We hypothesized that ultrasound characteristics of breast fibroadenomas (FA) vary in relation to the clinical and histological parameters: patient age, tumor size and histological classification. MATERIALS AND METHODS: Eleven ultrasound characteristics frequently observed in breast tumors were defined before the onset of our study. These characteristics, as well as a semi-quantitative score for vascularization on color-coded Doppler ultrasound, were analyzed in a retrospective study. Histology revealed adult type differentiation in all FA. They were divided into florid, regressive and mixed subtypes. The examiner was blinded for the histological classification during image analysis. RESULTS: Histological type: florid FA: more frequent in younger women (age group < 30 years; p < 0.001), and bigger than regressive FA (larger than 16 mm: p = 0.007). Statistically significant differences between florid and regressive FA regarding the ultrasound features: enhanced posterior ultrasound transmission (p < 0.001), homogenous echo pattern (p = 0.003) and lobulated margin contour (p = 0.042). Tumor size: patients with larger tumors (> 16 mm) were younger (mean age 35 vs. 43 years, p < 0.001). More often in bigger FA: enhanced dorsal ultrasound transmission (p < 0.001), hyperechoic spots (p < 0.001), strong vascularization (p < 0.001), inhomogeneous echo pattern (p = 0.001), horizontal axis (p = 0.009), lobulated margin contour (p = 0.009), lateral shadowing (p = 0.047). Age: more often in older patients (age group > 30 years): dorsal ultrasound shadowing (p = 0.008), irregular margin contour (p = 0.038), homogenous echo pattern (p = 0.047). CONCLUSION: Histological type, tumor size and patient age significantly influence ultrasound characteristics of breast FA. This might be helpful to consider when breast lesions are classified and decisions for biopsies are made.

Missteps when mice with lymphatically insufficient tails leap from molecular biology to human clinical lymphology.

A cautionary note is provided about making translational leaps from molecular biology and murine lymphedema models to clinical lymphology.

Three-dimensional ultrasound for the assessment of breast lesions.

OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional (3D) ultrasound in comparison with conventional two-dimensional (2D) ultrasound in the characterization of breast lesions. METHODS: The digitally stored 2D ultrasound images and the corresponding 3D scans of 100 breast lesions (57 malignant, 43 benign) that had been morphologically classified as solid tumors, were independently analyzed by six investigators. Ten 2D and 13 3D ultrasound characteristics were determined. Lesion characterization was classified on a four-point scale and a logistic regression model was used to analyze the data. A receiver-operating characteristics curve (ROC) analysis was performed to determine the diagnostic performance of 2D and 3D ultrasound, respectively. RESULTS: Ultrasound criteria showed major differences between 2D and 3D ultrasound. Logistic regression revealed the retraction phenomenon in the coronal plane of the 3D ultrasound scan to be a significant and independent factor for lesion characterization. The characteristics determined on the conventional planes of 3D ultrasound differed from those determined on the 2D ultrasound images. The diagnostic accuracy of 2D and 3D ultrasound in the ROC analysis was almost identical (area under the curve 0.846 and 0.851, respectively). CONCLUSIONS: Ultrasound features on 3D ultrasound differ significantly from those on 2D ultrasound. However, the diagnostic accuracy of both methods is almost identical. 3D ultrasound as an adjunct to conventional 2D ultrasound should be evaluated in larger trials to determine its clinical value in breast imaging.

Symptomatic skeletal muscle metastasis and elephantiastic lymphedema in a patient with recurrent ovarian carcinoma.

BACKGROUND: Distant tumor metastases in ovarian cancer patients in striated muscles are extremely rare. So far, only one case of metastatic but asymptomatic spread to striated muscle has been described. CASE: A patient with recurrent ovarian carcinoma presented with a gluteal mass 1 week following optimal debulking surgery. CT and MRI initially suggested muscle necrosis or intramuscular bleeding. Increasing pain and massive lymphedema led to immobilization and clinical deterioration. Repeated ultrasound and CT-guided biopsy confirmed the diagnosis of skeletal muscle metastases. CONCLUSION: This is the first case description of distant skeletal muscle metastasis as the leading clinical symptom of late stage ovarian carcinoma. It reveals possible limitations of CT and MRI as diagnostic tools for early identification of striated muscle metastases.

The role of operative management of varicose veins in patients with lymphedema and/or lipedema of the legs.

The role of operative management of "symptomatic" varicose veins in patients with lower extremity lymphedema or lipedema is controversial. We reviewed the clinical outcome of 261 patients between 1989-1997 at the Földiclinic with lower extremity lymphedema (68 patients), lipo-lymphedema or lympho-lipedema (103 patients) or lipedema (90 patients) who had undergone operation for varicose veins. In each group, the results were dismal as leg swelling worsened or was unchanged in greater than 90% whereas symptoms such as heaviness, fatigue, cramps (termed varicogenic symptomatology) were improved in less than 10%. These findings support that operations for varicose veins in the legs of patients with lymphedema, lipedema, or combinations of these disorders should be undertaken only if there is an absolute indication present (ascending phlebitis and/or bleeding). Otherwise, complete decongestive physiotherapy is still the best treatment approach for these groups of patients.

Benign supraclavicular tumorous lymphangiectasia--a new disease?

We describe an isolated recurrent non-inflammatory tumorous swelling of the supraclavicular fossa in four premenopausal women. Ultrasonography, magnetic resonance imaging and computer tomography of the neck each suggested an inhomogeneous mass consistent with "lymphangioma." In each patient the clinical course and histopathologic findings suggested that the swellings were due to chronic localized lymph stasis with subsequent lymphangiectasia, possibly initiated by intermittent obstruction of the juncture of the thoracic or right lymph duct with the internal jugular vein. Enlargement may have been hormonally triggered by estrogens as each woman was taking oral contraceptive pills at the onset of the disease. To characterize this unique entity, we have termed the disorder benign supraclavicular tumorous lymphangiectasia.