Estimating the incidence of cancers in Switzerland: 1983-1987.

Estimates have recently been made of the incidence of cancers in the countries of the European Community. Similar estimates are given for Switzerland, based on data from the six Swiss cantonal cancer registries, all of which have been operating for at least 12 years. These registries cover Basel, Geneva, Neuchatel, St Gall and Appenzell, Vaud and Zurich, which account for about 50% of the Swiss population as a whole. Two different methods were used to extrapolate from the incidences observed in the regions covered by cancer registration to the entire country. The first method is based solely on the distribution of populations according to the country's main linguistic groups, whereas the second relies on mortality data. Estimates obtained by the second approach are presented and their reliability is discussed. Comparison of the age incidence curve with that of Denmark tends to confirm the validity of the estimations. Estimated standardised rates (world population) for all sites except nonmelanomatous skin cancer are 294.3 for males and 214.2 for females. Comparisons with other European countries show that in males, lung cancer is relatively less common in Switzerland, whereas in females, breast cancer is relatively more frequent.

Induction of EAE in mice with recombinant human MOG, and treatment of EAE with a MOG peptide.

Myelin oligodendrocyte glycoprotein (MOG) is a transmembrane glycoprotein expressed on the surface of central nervous system (CNS) myelin membranes, which has been shown to induce experimental autoimmune encephalomyelitis (EAE) in rodents. Here we describe the induction of EAE in SJL and (PLJ X SJL)F1 mice with truncated human recombinant MOG (thr-MOG, amino acids 1-120) which has been expressed in insect cells in soluble form. We show that in SJL mice, immunization with thr-MOG produces an immune response to the 1-30 and the 81-110 regions of the MOG molecule. We also demonstrate effective treatment of thr-MOG-induced EAE in SJL mice with intravenous injections of a single peptide, MOG 91-110. These results support the possibility of treating MS using an antigen dependent approach.

Molecular cloning and sequencing of cDNAs encoding insecticidal peptides from the primitive hunting spider, Plectreurys tristis (Simon).

Plectreurys tristis cephalothorax mRNA was isolated and amplified by PCR using degenerate primers corresponding to reverse translated mature Plt-VI toxin. An oligonucleotide corresponding to a portion of the amplified product was then used to screen a P. tristis cDNA library. The cDNAs from 10 positive clones were sequenced. Eight of these cDNAs corresponded to Plt-VI toxin, one to Plt-XI toxin, and one was very similar to Plt-VIII toxin, with the exception of a single amino acid substitution. Analysis of these cDNAs indicated that these toxins are initially synthesized as prepro-forms which undergo signal cleavage followed by additional processing at both their N- and C-termini to produce the mature products.

Adjuvant chemoimmunotherapy with LMF plus BCG in node-negative and node-positive breast cancer - intermediate report at 4 years.

A randomized surgical adjuvant trial in 242 evaluable patients with T1-3a, N0-1, and M0 breast cancer was initiated 4 years ago. The well-tolerated, oral combination chemotherapy with six cycles of Leukeran plus methotrexate plus fluorouracil (LMF) plus repeated BCG skin scarifications was used. After 4 years, the following results were seen: (1) significant increase of relapse-free (RFS) and also overall survival (S) in both pre- and postmenopausal node-negative patients versus surgical controls (RFS 91.1 vs. 701%, P = 0.003; S 96 vs. 88%, P = 0.03); (2) no significant increase of RFS or S in pre- and postmenopausal node-positive patients versus surgical controls (RFS 50.1 versus 44%, P = 0.49; S 70 versus 68 %, P = 0.9, respectively); (3) Patients receiving greater than 90% of the planned LMF dose showed significantly better survival after 4 years; and (4) Nonrandomized comparison with concurrent Swiss adjuvant studies with LMF alone indicate no beneficial or harmful effect of BCG skin scarifications in addition to the six-cycle LMF.

Etiologic and prognostic significance of isolated acute renal hypoxic change (so-called tubular necrosis or shock kidney) in kidney transplants.

20 biopsies were studied in order to determine whether or not the pathologist is able to predict on morphological grounds the etiology and prognosis of acute renal hypoxic change in renal transplants. We concluded that: 1) Intertubular blood stasis seems to be pathognomonic of peripheral vascular rejection and/or renal artery thrombosis. 2) A focal distribution of acute tubular luminal dilatation suggests peripheral vascular rejection. 3) The finding of lymphatic casts suggests the presence of ureteric obstruction. 4) Linear fluorescent staining of the peripheral glomerular basement membrane appears to be due to leakage of plasma proteins in the presence of endothelial damage. 5) The histological distinction between camouflaged rejection and genuine shock kidney is impossible in a biopsy. 6) The precise cause of acute renal hypoxic change and the prognosis of kidney transplants with this alteration often cannot be determined.

[Swiss interregional epidemiologic study of the risk of cancer in the contralateral breast]. / Etude épidémiologique inter-régionale suisse du risque de tumeur controlatérale du sein.

This epidemiologic investigation in three Swiss regions (Geneva, St. Gall-Appenzell, Vaud) included 5,193 women diagnosed as having a first primary breast cancer. The patients were followed up for ten years (the observation totalled 24,994 women-years). Overall, these results confirmed that the relative risk of a second breast cancer was greatly increased during the first year following the primary diagnosis, but this was largely due to simultaneously discovered contralateral tumours. Beyond the first year of follow-up, the relative risk of a second tumour was lower but still significantly greater than unity. No significant diminution of the excess risk was observed in the first 10 years of follow-up. Relative risk of a second breast cancer was generally higher before age 50, independently of the latency. The relative risk of a second breast cancer differed significantly from one region to another, possibly due to specific techniques of registration.

Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign.

A national information program, focusing on the main recognized risk factors (primary prevention) and on the potential benefits of early detection (secondary prevention) of cutaneous malignant melanoma, was launched in Switzerland in May 1988. The first campaign, based on a pilot study conducted in 1986 in the canton of Basel, was followed by a recall campaign in July 1989. This report describes the organization of this program and presents an assessment of its initial impact. The number of newly diagnosed cases increased more than twofold (+ 116%) in the two months following the launch of the first campaign (May to June 1988). This trend was accompanied by a statistically significant shift of case distribution towards younger ages (< 60 years; p = 0.003), and a non-significant shift was observed towards less advanced lesions (thickness < or = 1.5 mm). The incidence decreased quickly, though in the twelve month period between the two campaigns it remained 21% higher than before the inception of the program. No appreciable effects were detected from the recall campaign and no difference was seen among regions or between sexes.

Colorectal cancer: the relationship of staging to survival. A cancer registry study of 800 cases in St. Gallen-Appenzell.

Proper classification of colorectal cancer has been critical in determining prognosis. Dukes' staging and its modifications have created considerable confusion. The TNM system has never been widely accepted because of its complexity. The Australian clinico-pathological staging (ACPS) system corresponds closely to Dukes' A, B, C-classification, but it differs from Dukes' in separating a stage D for incurable metastatic disease. Evaluating the compatibility of these 3 different staging systems, a survival analysis is presented of a group of 800 non-selected patients, resected in curative or palliative intention and compiled from the cancer registry of St. Gall-Appenzell. The prognostic importance of accurate staging for colorectal cancer is confirmed. No matter which system is used, in order to give realistic statements it must be based on tumor penetration, lymph node involvement and distant metastasis.

[Pheochromocytoma and pregnancy]. / Phéochromocytome et grossesse

The authors have taken the opportunity presented them by having a case of pheochromocytoma observed and diagnosed in the puerperium, of reviewing the various clinical and diagnostic features appropriate to this chromaffin tissue tumour. They also review the cardinal points in the differential diagnosis of any case of arterial hypertension discorvered in connection with pregnancy. A study of the literature shows that failure to recognise pheochromocytomata in pregnant women is accompanied by particularly hight maternal and fetal mortality. This complication of pregnancy, although rare, should be recognised by the obstetrician, who will be in a much better position early to combat and palliate the very grave threat to the mother and her baby.

[Treatment of vulvar cancer]. / Behandlung des Vulvakarzinoms.

125 patients with carcinoma of the vulva were evaluated with respect to corrected 5-year survival rates. In our study we try to answer two questions in the therapeutic management of vulval carcinoma: (1) Is organ-preserving surgery in stage I tumors adequate? (2) How important is the radiation therapy in the general treatment concept in more advanced stages of the disease? Our study shows that organ preservation seems to be possible in stage I disease, if resection of the tumor is complete with a margin of normal tissue. If inguinal lymph nodes are involved or the primary tumor is bulky, the best results are obtained with a combination of radical surgery and locoregional radiation therapy. Radiation therapy alone has a good effect during the early stage of the vulval cancer.

[Carcinoma of the papilla: bypass, Whipple, or papillectomy?]. / Papillenkarzinom: Umgehung, Whipple oder Papillektomie?

The records of 41 patients who had carcinoma of the ampulla of Vater in the period 1952-1973, are reviewed. Palliative operations were disappointing in 16 patients since they resulted in an average survival of only a few months. The most impressive results were obtained with the one-stage Whipple procedure and, in selected cases, by simple papillectomy with survival of up to 6 years. However, not every surgeon is able to deal competently with the difficult problems of malignant jaundice. Special technical and tactical skill is a precondition and systematic diagnostic evaluation as well as modern intensive care are necessary for good results. The ampullomas have the best prognosis in the group of peripapillary tumors.

[Spontaneous rupture of the oesophagus. Report of two cases]. / Die spontane Oesophagusrupture. Kasuistischer Beitrag zweier Fälle

Case report of two so-called spontaneous ruptures of the oesophagus. The early diagnosis saved one of the patients, in the other the sequelae of the oesophagus rupture were treated successfully by intensive care. He died one month later from stress ulcers in the stomach and duodenum.