An intelligent visualisation and decision support system for decentralised wastewater treatment plants

Current sanitation concepts of decentralised wastewater treatment and reuse raise the issue of monitoring and maintenance of such systems. To guarantee high quality of the recycled water, systems with high requirements concerning process technology are essential. With increasing numbers of decentralised treatment systems spread over far distances it will become more and more impossible and uneconomic to have expert personnel on site. Therefore, new visualisation and intelligent information systems are necessary. The paper describes the structure and 3D-demonstrations as a base for information visualisation. Up-to-date visualisation techniques, facilitating the cognition of context-adapted information, make it possible to maximise the amount of information presented to the user without overwhelming her or him. Concerning diagnosis and decision support systems in the domain of wastewater treatment, several interesting approaches are presented, estimating their applicability for decentralised wastewater treatment systems. The intelligent decision support system presented here consists of a combined ontology- and case-based reasoning system in addition to a process monitoring system. It is responsible for plausibility checks, error diagnosis, solution proposals, and optimisation suggestions.

Differentiated dopaminergic MN9D cells only partially recapitulate the electrophysiological properties of midbrain dopaminergic neurons

The cell line MN9D, a fusion of embryonic ventral mesencephalic and neuroblastoma cells, is extensively used as a model of dopamine (DA) neurons because it expresses tyrosine hydroxylase and synthesizes and releases DA. These cells are also used to test mechanisms and potential therapeutics relevant to the loss of DA neurons in Parkinson's disease. To date, little work has been done to determine whether MN9D cells electrophysiologically resemble mature DA neurons. We examined sodium, calcium and potassium currents in undifferentiated and differentiated MN9D cells, and compared these to those found in acutely dissociated mouse substantia nigra pars compacta DA neurons. It was observed that undifferentiated MN9D cells bore no resemblance to DA neurons. Upon differentiation with butyric acid with or without a prior treatment with glial cell line-derived neurotrophic factor, differentiated MN9D cells produce an electrophysiological profile that more closely resembles substantia nigra pars compacta DA neurons even though the A-type potassium current remains noticeably absent. These observations demonstrate that undifferentiated MN9D cells are not reasonable models of DA neurons. Although differentiated MN9D cells are closer to the mature DA neuronal phenotype, they do not fully mimic DA neurons and are likely to be of questionable value as a model because of their substantive differences, including the lack of the characteristic A-type potassium current. The future use of one or a combination of growth or other factors to differentiate MN9D cells may yield a more useful model system for Parkinson's disease studies in vitro.

Technique for rapid in vitro single-cell elastography

Statistically meaningful assays require scanning a large number of cells in a short time. Here we present a technique for rapid in vitro single-cell elastography. The technique is based on atomic force acoustic microscopy but (1) requires only a few minutes of scan time, (2) can be used on live cells briefly removed from most of the nutrient fluid, (3) does negligible harm or damage to the cell, (4) provides semiquantitative information on the distribution of modulus across the cell and (5) yields data with 1- to 10-nm resolution. We describe the new technique in detail, apply it to baby hamster kidney cells, verify the results and calibrate the images with atomic force microscope force-distance measurements. The technique enables rapid assessment of physical/biochemical signals on the cell modulus and contributes to current understanding of cell mechanics.

Human neural progenitors deliver glial cell line-derived neurotrophic factor to parkinsonian rodents and aged primates

Glial cell line-derived neurotrophic factor (GDNF) has been shown to increase the survival and functioning of dopamine neurons in a variety of animal models and some recent human trials. However, delivery of any protein to the brain remains a challenge due to the blood/brain barrier. Here we show that human neural progenitor cells (hNPC) can be genetically modified to release glycosylated GDNF in vitro under an inducible promoter system. hNPC-GDNF were transplanted into the striatum of rats 10 days following a partial lesion of the dopamine system. At 2 weeks following transplantation, the cells had migrated within the striatum and were releasing physiologically relevant levels of GDNF. This was sufficient to increase host dopamine neuron survival and fiber outgrowth. At 5 weeks following grafting there was a strong trend towards functional improvement in transplanted animals and at 8 weeks the cells had migrated to fill most of the striatum and continued to release GDNF with transport to the substantia nigra. These cells could also survive and release GDNF 3 months following transplantation into the aged monkey brain. No tumors were found in any animal. hNPC can be genetically modified, and thereby represent a safe and powerful option for delivering growth factors to specific targets within the central nervous system for diseases such as Parkinson's.

PSYCHOSOCIAL AND PSYCHOSEXUAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE WITHIN THE EXSTROPHY-EPISPADIAS COMPLEX

PURPOSE

We report the psychosocial and psychosexual development of children and adolescents with the exstrophy-epispadias complex (EEC) after complete functional repair using the Erlangen single stage technique.

MATERIALS AND METHODS

In a long-term retrospective followup of an average of 11.1 years 100 patients with EEC (76 boys and 24 girls, mean age 14.5 years) were evaluated with respect to medical history, and received a general questionnaire concerning their social and psychosocial situation. A total of 54 patients who were 15 years or older (mean age 18.5) received an additional questionnaire to assess detailed sexual history.

RESULTS

Of the patients 81% returned the general questionnaire within 3 weeks. School education level and social integration were high. In about 25% of the patients impairment of daily life was significant, and in 58.7% peer relations were altered. Of the adolescent group 76% answered the special questionnaire. Genital satisfaction and genital touching were rated low, and avoidance of nudity in public areas was common. All patients expressed heterosexuality and 43.9% had engaged in sexual intercourse but 58.5% displayed anxiety about sexual activity. It is noteworthy that 93.9% expressed an interest in psychological assistance.

CONCLUSIONS

Despite a high degree of social integration and adult adaptation, children and adolescents with EEC suffer from psychosocial and psychosexual dysfunction requiring special questionnaires for adequate assessment. Anxiety about genital appearance and sexual activity is a common phenomenon among adolescents with EEC, even when they present with nearly "normal" genitalia and participate with satisfaction in sexual activity. Further studies are needed to understand the exstrophy problem and supply all patients with EEC with the individual care they need.

Cardiac safety of trastuzumab in combination with epirubicin and cyclophosphamide in women with metastatic breast cancer

This prospective, parallel-group, dose-escalation study evaluated the cardiac safety of trastuzumab (Herceptin) plus epirubicin/cyclophosphamide (EC) in women with human epidermal growth factor receptor-2 (HER2)-positive metastatic breast cancer (MBC) and determined an epirubicin dose for further evaluation. HER2-positive patients received standard-dose trastuzumab plus epirubicin (60 or 90 mg/m(2))/cyclophosphamide (600 mg/m(2)) 3-weekly (EC60+H, n=26; EC90+H, n=25), for four to six cycles; 23 HER2-negative patients received EC alone (90/600 mg/m(2)) 3-weekly for six cycles (EC90). All patients underwent thorough cardiac evaluation. Two EC90+H-treated patients experienced symptomatic congestive heart failure 4.5 and 6 months after the end of chemotherapy. One EC60+H-treated patient experienced an asymptomatic decrease in left ventricular ejection fraction (LVEF) to <50% 6 months after the end of chemotherapy. No such events occurred in control patients. Asymptomatic LVEF decreases of >10% points were detected in 12 (48%), 14 (56%) and 5 (24%) patients treated with EC60+H, EC90+H, and EC90. Objective response rates with EC60+H and EC90+H were >60%, and 26% for EC90 alone. These results indicate that trastuzumab may be combined with EC with manageable cardiotoxicity and promising efficacy.

Scalable mobile information system to support the treatment process and the workflow of wastewater facilities

In order to support the operation of wastewater systems and the workflow of sewage systems an application for demonstration has been developed to show exemplarily how a mobile information system can be transferred into practice and used by the staff. The paper presents a scalable information visualisation system, which can be used with mobile devices. The regarded information data does not only include process data, but also general information about buildings and units, work directions, occupational safety regulations as well as instructions of first aid in case of a work accident. This is particularly appropriate for the use in remote facilities. The implementation is based on but not limited to SQL, JSP and HTML.

[The frequency-doubled double-pulse Neodym:YAG laser lithotripter (FREDDY) in lithotripsy of urinary stones. First clinical experience]

Laser lithotripsy does not play an important role in urinary stone treatment, mostly due to ineffective fragmentation efficiency, and high purchase and maintenance costs. The aim of the following retrospective study was to show the clinical significance and efficiency of an innovative laser lithotripsy system for urinary stone treatment. Between November 1998 and October 1999, 48 patients were treated with the innovative frequency- doubled double-pulse Neodym: YAG laser lithotripter FREDDY. A total of 50 renal units were treated, 43 ureteroscopically, four ureterorenoscopically, three percutaneous-nephroscopically, and one bladder stone cystoscopically. With a median laser operation time of 5 min (range: 1-30 min) and a total procedure duration of 60 min (range: 15-180 min), a stone-free rate of upper ureteral stones of 62%, middle ureteral stones of 91% and distal ureteral stones of 100% were documented on the first day after treatment. In an observation period of 6 months, no complications were seen. In our experience Laser lithotripsy with FREDDY is an effective, simple and reliable method for the treatment of ureteral stones, with low purchase and maintenance costs. The extremely thin and highly flexible quartz fibre may extend the endoscopic spectrum to otherwise poorly accessible upper ureteral stones, the renal pelvis and renal calix stones. Therefore, a prospective validation study for comparison with ballistic lithotriptors is of great interest.

[Effectiveness of syringe shieldings using radionuclides in radiation synovectomy]

AIM

The radiation exposure in radiation synovectomy was investigated for technician and therapist using Erbium-169, Rhenium-186 and Yttrium-90 with and without syringe shieldings.

METHODS

Dose rates were measured in relation to the distance of the syringe containing the radionuclide. Measurements were repeated using syringe shieldings which consist of plastic surrounded by a lead layer.

RESULTS

The most relevant radiation exposure arises from Yttrium-90. Using syringe shieldings radiation exposure can be reduced by a factor of thousand.

CONCLUSION

This kind of radiological protection is completely sufficient for the therapist. Concerning the technician preparing the radiopharmaceutics, the limit of the official German dosimetry service (500 mSv) might be exceeded if no special radiological protection is established. Thus, special dosimetry is recommended.

[Renal cell carcinoma in childhood. Case report and review]

Renal cell carcinoma (RCC) in childhood is rare and its incidence is estimated to be 3-6% of all kidney cancers in childhood. Thus, clinical experience with renal cell carcinoma in this age group is meager and no consensus between pediatric urologists and pediatric oncologists exists on common treatment strategies. Furthermore, most previous reports included postpubertal patients in whom the biological behavior of the RCC and treatment options are the same as in adults. Based on the literature and a clinical case report of a 12-year-old boy suffering from a papillary renal cell carcinoma stage IV (pT2 N2 MO), the relevance of the biological behavior of different histological subtypes and their treatment options are reviewed and discussed. In adulthood lymph node dissection is still controversial, but in children it seems to have a positive effect on survival. Immunotherapy in childhood is still and experimental option and just a few cases are reported in the literature.

Foetal lung maturation in 11beta-hydroxysteroid dehydrogenase type 1 knockout mice

Glucocorticoids (GCs) induce surfactant synthesis in the late foetal lung. Deficient GC action causes respiratory distress syndrome (RDS). 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) converts inert cortisone (11-dehydrocorticosterone in rodents) into active cortisol (corticosterone), thus amplifying intracellular GC action. Reduction or loss of pulmonary 11beta-HSD1 activity in glycyrrhetinic acid-treated rats substantially impaired foetal lung maturation (Hundertmark et al., Horm Metab Res, this issue). To test these data, we investigated 11beta-HSD1 activity and lung maturity in the late foetal lung using 11beta-HSD1 knockout mice. Control foetal mice showed high 11beta-HSD activity in the late foetal lung and levels of plasma 11-dehydrocorticosterone were high. Lungs from 11beta-HSD1 -/- mice had lower surfactant protein-A (mRNA and protein) levels and significant depletion of lung surfactant according to both light and electron microscopy, and also had reduced amniotic fluid lecithin/sphingomyelin ratios. These results support the previous experiments with glycyrrhetinic acid and emphasize the importance of 11beta-HSD1 in foetal lung maturation.

Current use of HER2 tests

Reliable detection of HER2 overexpression is important for the success of trastuzumab (Herceptin) therapy. Several methods are available for measuring HER2 expression at the DNA, RNA or protein level. The method most frequently employed is immunohistochemical (IHC) detection of the HER2 receptor in paraffin sections. Advantages include the precise localization of the HER2 protein, the availability of paraffin material and the ease of the procedure. However, IHC can be influenced by the sensitivity/specificity of the antibody, tissue treatment and, in particular, subjective assessment. These disadvantages do not exist in the detection of gene amplification by fluorescence in situ hybridization (FISH) or polymerase chain reaction. However, FISH requires expensive equipment that is not widely available in pathology laboratories. Another approach quantitates shed HER2 antigen in the serum by an enzyme-linked immunosorbent assay. The key advantage of this method is the ease of sampling blood, however, serum HER2 concentrations do not accurately reflect the tumor status. Furthermore, this method does not register single-cell expression, which is important for therapeutic decision making. For routine diagnostics, the combination of IHC and FISH is useful. In addition to improving the accuracy and comparability of HER2 assays, these optimized protocols may further enhance the efficacy of trastuzumab therapy by selecting those patients most likely to respond.

[The impact of pregnancy-prolonging management on maternal and neonatal morbidity in HELLP syndrome]

OBJECTIVE

Until recently, delivery immediately after diagnosing HELLP syndrome was recommended due to the life-threatening risk to mother and child. Prolongation at least until lung maturation is being increasingly considered because of the high rate of premature births characterized by extreme immaturity. We investigated the influence of the time of delivery on maternal and neonatal morbidity at a gestational age of less than 34 + 0 weeks of pregnancy. -

MATERIAL AND METHODS

The disease course was reevaluated in 37 patients who developed HELLP syndrome (thrombocytes < 100 000/microl, transaminase > 70 U/l, haptoglobin < 0.5 g/l) between 1994 and 1999. An attempt was made to stabilize the mother's condition under therapeutic volume expansion. Pregnancy was terminated with the onset of a renewed HELLP episode. -

RESULTS

HELLP syndrome occurred with an incidence of 1 : 310 births. There were no maternal or neonatal deaths or any severe complications. Prolonging pregnancy until completing drug-induced lung maturity was successful in 16 of 25 patients before the 34(th) week of pregnancy. In the case of immediate delivery with inadequate stabilization, 5 of 9 patients had postpartum complications. A severe RDS occurred in 3 premature babies without drug-induced maturity. -

CONCLUSION

If there is no life-threatening risk to the fetus or mother in patients with HELLP syndrome, the objective is the prolongation of pregnancy in a perinatal center until lung maturation. Stabilization is successful in a high percentage of patients under therapeutic volume expansion with optimal monitoring of mother and child.

Chick CFC controls Lefty1 expression in the embryonic midline and nodal expression in the lateral plate

Members of the EGF-CFC family of proteins have recently been implicated as essential cofactors for Nodal signaling. Here we report the isolation of chick CFC and describe its expression pattern, which appears to be similar to Cfc1 in mouse. During early gastrulation, chick CFC was asymmetrically expressed on the left side of Hensen's node as well as in the emerging notochord, prechordal plate, and lateral plate mesoderm. Subsequently, its expression became confined to the heart fields, notochord, and posterior mesoderm. Implantation experiments suggest that chick CFC expression in the lateral plate mesoderm is dependent on BMP signaling, while in the midline its expression depends on an Activin-like signal. The asymmetric expression domain within Hensen's node was not affected by application of FGF8, Noggin, or Shh antibody. Implantation of cells expressing human or mouse CFC2, or chick CFC on the right side of Hensen's node randomized heart looping without affecting expression of genes involved in left-right axis formation, including SnR, Nodal, Car, or Pitx2. Application of antisense oligodeoxynucleotides to the midline of Hamburger-Hamilton stage 4-5 embryos also randomized heart looping, but in contrast to the overexpression experiments, antisense oligodeoxynucleotide treatment resulted in bilateral expression of Nodal, Car, Pitx2, and NKX3.2, whereas Lefty1 expression in the midline was transiently lost. Application of the antisense oligodeoxynucleotides to the lateral plate mesoderm abolished Nodal expression. Thus, chick CFC seems to have a dual function in left-right axis formation by maintaining Nodal expression in the lateral plate mesoderm and controlling expression of Lefty1 expression in the midline territory.

Identification of Cripto-1 in human milk

Cripto-1 (CR-1) is an epidermal growth factor (EGF)-related peptide that plays an important role in normal mammary gland development. CR-1 is expressed in the growing terminal end buds in the virgin mouse mammary gland and its expression increases during pregnancy and lactation. Furthermore, CR-I is involved in the early stages of mouse mammary tumorigenesis and in the pathogenesis of human breast cancer. Since CR-1 is expressed in the mouse mammary gland at high levels during pregnancy and lactation, we have evaluated whether this protein is present in human milk. In the present study we demonstrate that a 28 kDa immunoreactive CR-1 protein is present in 24 human milk samples as assessed by western blot analysis and that by enzyme-linked immunosorbent assay the concentration of CR-1 ranges between 62 and 118 ng/ml. In addition, CR-1 that had been purified from human milk is able to stimulate the phosphorylation of mitogen activated protein kinase in nontransformed NMuMG mouse mammary epithelial cells. These results suggest that CR-1 in human milk may be important in regulating mammary gland development during pregnancy and lactation.

Cripto-1 induces apoptosis in HC-11 mouse mammary epithelial cells

Cripto-1 (CR-1) is an epidermal growth factor (EGF)-related protein. CR-1 can inhibit beta-casein and whey acidic protein expression in mouse mammary epithelial cells. The present study demonstrates that CR-1 can induce apoptosis in HC-11 mouse mammary epithelial cells, as measured by bis-benzimide stained nuclei, TUNEL assay and cell death ELISA. Apoptosis could be observed after 2 days of exposure of confluent HC-11 cells to CR-1 in the absence of the survival factors EGF and insulin, with maximum apoptosis occurring at 3 days. A reduction in poly(ADP-ribose) polymerase (PARP) expression and an increase in beta-catenin cleavage was found after 18 h of exposure to CR-1 suggesting that apoptosis was preceded by the induction of a caspase activity since the caspase inhibitor ZFAD.FMK could block the CR-1-induced reduction in PARP expression and CR-1-induced apoptosis. CR-1 was found to increase the expression of caspase-3-like protease. Although, the levels of p27kip1 and p21Bax did not change after exposure to CR-1 for 18 h, the levels of Bcl-xL became undetectable. These studies suggest that CR-1 promotes apoptosis by mediating the induction of caspase-3-like protease and downregulating the expression of Bcl-xL.

[Hepatocellular carcinoma as a rare cause of excessive rise in alpha-fetoprotein in pregnancy]

OBJECTIVE

Elevation of alphafetoprotein in pregnancy warrants a thorough diagnostic workup. In most cases, no pathologic result in the fetus will be obtained.

CASE REPORT

A case report is presented on a hepatocellular carcinoma (HCC) during pregnancy, in which a massive increase of alpha-fetoprotein (AFP) was found during a routine screening for neural tube defects in the 17th week of gestation. The amniocentesis revealed a normal AFP value in the amniotic fluid. Liver sonography in the 21st week of gestation showed a 5 cm tumor, which was interpreted as nodular focal hyperplasia. In the control sonography in the 32nd week of gestation, there was a growth to 12 cm. The subsequently performed magnetic resonance imaging (MRI) and fine needle aspiration led to the diagnosis of a HCC. Delivery was performed in the 34th week of gestation by cesarean section followed by surgical therapy of the HCC.

CONCLUSIONS

Unexplained cases of alphafetoproteinelevation in pregnancy can be caused by maternal disease and should prompt a directed amnamnestic and diagnostic search for maternal causes. Nuclear magnetic resonance beyond the first trimester of gestation can help to clarify the diagnosis in liver tumors.

[The clinical importance of keratin 18 in breast cancer]

OBJECTIVE

This study was performed to determine the prognostic significance and the biological function of the structure protein keratin 18 (K18) in a group of patients with breast cancer.

MATERIAL AND METHODS

Paraffin sections from the primary tumors in 80 patients with breast cancer were examined for the expression of K18 by immunohistochemical staining with the monoclonal antibody CK2. The intensity of the expression measured by an immune reactive score (IRS) was compared with clinicopathological variables and follow-up data up to 10 years. Additionally K18 expression in different human breast cancer cell lines with well defined metastatic behavior were investigated to confirm the clinical data.

RESULTS

A marked positive staining was observed in 13 (16.2%) women. Mortality rate in this group was 7.7% and 46.3% in the group with a low K18 expression. The recurrence rate was with 15.4% significantly lower in the positive group than in the negative group with 56.7%. Irrespective of the morphological tumor stage, almost all patients with strong K18 expression were still free of disease after 10 years. This clinical finding is supported by observations in cell cultures.

CONCLUSIONS

In our collective K18 expression was found to be an independent and significant predictor for disease-free and overall survival.

Lymph node involvement in renal cell carcinoma and survival chance by systematic lymphadenectomy

BACKGROUND

The value of systematic lymphadenectomy has been a matter of great controversy for a long period of time. A recently published paper of a retrospective autopsy study generally doubts its therapeutic effectiveness, arguing that positive lymph nodes are nearly always associated with distant metastases.

PATIENTS AND METHODS

Between 1974 and 1993 1035 patients suffering from renal cell carcinoma with stages from cT 1 to 4, cM 0 were treated with curative intention. 51% underwent radical abdominal tumour nephrectomy with systematic lymphadenectomy (n = 531, group A). In 199 patients (19%, group B) only macroscopically suspect lymph nodes were removed surgically. All other patients underwent radical lumbar tumour nephrectomy without lymphadenectomy (n = 305, 29%, group C).

RESULTS

Mean age of group A was 55.5 +/- 10 years, B 60.3 +/- 11 and C 66.5 +/- 11. Median follow-up for all groups was 115 +/- 63 months. Median amount of removed lymph nodes was 18 in group A, 6 in group B and 3 in group C. N-categories for each group were pN 1: 4%, 2%, 1%; pN 2: 7%, 5%, 1%; pN 3: 3%, 2, %, 1%; pN x: 0%, 35%, 67% respectively. Group A with systematic lymphadenectomy had the least favourable tumour stage overall. Nevertheless long-term survival of this group is more favourable with 57% +/- 6 when compared to group B with 50 +/- 12% and C with 44% +/- 9%. 20 (27%) of the 75 lymph node positive patients of group A who have been followed-up for more than 5 years are still alive.

CONCLUSIONS

At least 4% of all patients benefit from extensive lymphadenectomy. This may only be a relatively small proven effect for the entire patient collective, but for a single lymph node positive patient this is an undoubtedly significant additional chance of survival especially when one notes that presently there is no curative adjuvant therapy.

AIDS counselling for low-risk clients

This study addresses the counselling of heterosexual men with low-risk behaviour who, voluntarily or involuntarily, take an HIV test. If such a man tests positive, the chance that he is infected can be as low as 50%. We study what information counsellors communicate to clients concerning the meaning of a positive test and whether they communicate this information in a way the client can understand. To get realistic data, one of us visited as a client 20 public health centres in Germany to take 20 counselling sessions and HIV tests. A majority of the counsellors explained that false positives do not occur, and half of the counsellors told the client that if he tests positive, it is 100% certain that he is infected with the virus. Counsellors communicated numerical information in terms of probabilities rather than absolute frequencies, became confused and were inconsistent. Based on experimental evidence, we propose a simple method that counsellors can learn to communicate risks in a more effective way.

Dosedependent photodynamic effects of 9-acetoxy-2,7,12,17-tetrakis(\-methoxyethyl)-porphycene in vitro

Porphycenes are chemically pure photosensitizers for topical and systemic photodynamic therapy (PDT). Fast cellular uptake of 9-acetoxy-2,7,12,17-tetrakis-(sB-methoxyethyl)porphycene (ATMPn) has been shown previously.HaCaT human keratinocytes were incubated with ATMPn (1 nmol l(-1) to 1 micromol l(-1) in DMSO or DOPC liposomes). After 1 h, cells were irradiated with different light doses (0, 24, 48J cm(-2)) using an incoherent light source (580-740 nm, 40 mW cm(-2)). Cytotoxic effects were determined by assessing the mitochondrial activity using the MTT assay 24 h following irradiation.Cytotoxic effects were dependent on ATMPn concentration and light dose. Using 20 nmol 1(-1), a 50% decrease of mitochondrial activity (EC(50)) after irradiation with 24 J cm(-2) was achieved. Lowering the ATMPn concentration (10nmol 1(-1)) and increasing the light dose (48 J cm(-2)) yielded the same effect (EC(50)). Maximal decrease of mitochondrial activity (90%) was achieved using ATMPn concentrations of 50-100 nmol l(-1) and a light dose of 24 J cm(-2) or 25 nmol l(-1) ATMPn and 48 Jcm(-2).There was no difference regarding the dose-dependent cytotoxic effects using either ATMPn in DMSO or DOPC liposomes. In the control group (incubation with 1 nmol 1(-1) to 1micromol 1(-1) ATMPn, no irradiation), dark toxicity was not observed.Cell photosensitization with ATMPn was very efficient in vitro yielding the maximal cytotoxic effect at very low ATMPn concentrations as compared to other photosensitizers. Since ATMPn in DMSO and DOPC liposomes revealed the same cytotoxic effects without dark toxicity, theDMSO formulation, which is much easier to prepare, will be preferred in future studies.

Short-term treatment with levonorgestrel does not antagonize the ethinyl estradiol-induced increase of uterine blood flow in postmenopausal women

The aim of this study was to determine the effect of a short-term ethinyl estradiol/levonorgestrel medication on blood flow in the uterine arteries in postmenopausal women in a prospective placebo-controlled double-blind study. Twenty-one healthy postmenopausal woman at least 2 years after menopause received 60 micrograms ethinyl estradiol (EE) for 14 days followed by 40 micrograms EE plus 125 micrograms levonorgestrel (LNG) for 12 days (total treatment period 26 days). Sonographically, uterine volume, endometrial thickness, and blood flow in the uterine arteries [as reflected by pulsatility (PI) and resistance indices (RI)] were measured. Uterine size increased from 44 to 80 mL (day 14, p < 0.001) and 87 mL (day 26, p = NS). Endometrium grew from 3 to 8 mm (day 14, p < 0.001) and 11 mm (day 26, p = NS). Uterine arterial PI fell from 2.76 to 1.37 (day 14, p < 0.001) and 1.34 (day 26, p = NS), whereas RI fell from 0.9 to 0.68 (day 14 and day 26, p < 0.001). In conclusion, short-term treatment with LNG does not antagonize the vascular effect of EE on the uterine arteries as reflected by PI and RI. This result might have clinical significance in the selection of the progestin used in hormonal replacement therapy.

Elevated keratin 18 protein expression indicates a favorable prognosis in patients with breast cancer

This study was performed to determine if keratin 18 (K18) has prognostic significance in breast cancer cell lines and patients with breast carcinoma. Paraffin sections of primary breast carcinoma tumors and human breast carcinoma cell lines were examined for K18 expression by immunohistochemical staining with the monoclonal antibody CK2. K18 protein expression was low in highly metastatic cell lines and, conversely, high in weakly metastatic cell lines, suggesting that it may function as a prognostic indicator. K18 expression was consequently examined in 134 patients with breast cancer. The staining intensity was compared with clinicopathological variables and follow-up data spanning 8 years. A definitive positive staining was observed in 22 (16.4%) women. The mortality rate was 4. 5% in the K18-positive group and 44.6% in the K18-negative group. Multivariate analysis found K18 expression to be an independent and significant predictor for overall survival.

Hepatocellular carcinoma as a rare cause of an excessive increase in alpha-fetoprotein during pregnancy

A case report is presented on a hepatocellular carcinoma (HCC) during pregnancy, in which a massive increase in alpha-fetoprotein (AFP) was found during a routine screening for neural tube defects in the 17th week of pregnancy. The amniocentesis revealed a normal AFP level in the amniotic fluid. Liver sonography in the 21st week of pregnancy showed a 5-cm tumor, which was interpreted as nodular focal hyperplasia. In the control sonography in the 32nd week of pregnancy, there was growth to 12 cm. The subsequently performed magnetic resonance imaging and fine-needle aspiration led to the diagnosis of a HCC. Delivery was performed in the 34th week of pregnancy by cesarean section, and surgical therapy of the HCC followed.

[Cystosarcoma phylloides of the breast. A retrospective analysis of 12 cases]

INTRODUCTION

Phyllodes tumours, also known as cystosarcoma phyllodes (CSP), are rare fibroepithelial tumours with an incidence of 0.3-1.0% of all breast neoplasms. CSP tends to recur locally and metastasizes haematogenously. The treatment of CSP remains controversial. The present study demonstrates the recent experiences in diagnosis, therapeutical management and clinical follow-up of this disease.

MATERIALS AND METHODS

Twelve female patients who developed CSP from 1982 to 1994 were recalled for clinical assessment and examined for local recurrence or metastatic disease. All histological samples from cases of CSP were evaluated by a single pathologist who was blinded to the patients' histories. The tumours were classified according to international criteria of three types of tumour status: benign CSP, borderline type tumours and malignant tumours.

RESULTS

The average age of disease was 46 years. Three patients had benign tumours. There was one borderline type of tumour and eight malignancies. Six patients with malignant CSP underwent mastectomy and axillary dissection. In two cases of malignant CSP simple mastectomy was performed. In two cases of malignancy the operation was followed by radiation therapy. The borderline type of tumour and the benign CSP were treated by tumour removal, segmental resection or subcutaneous mastectomy. In one case of benign CSP two more benign recurrencies ocurred 18 months after the initial operation. Preoperative determination of the tumour marker CEA was normal. The tumour marker CA 15-3 was only elevated in one case. The growth fraction varied from 5-40%. In 8/8 patients the oestrogen and progesterone receptors were negative. We could not find any correlation between the development of cystosarcoma phyllodes and oral contraceptives, nicotine use, diabetes mellitus, age of menarche, allergies, or family history of cancer.

CONCLUSION

The clinical finding of a large, firm, non-tender, well-defined, mobile tumour with gradual growth should lead to a suspicion of a phyllodes tumour. Our results and the review of the current literature lead to the following therapeutic recommendations: 1. Benign phyllodes tumour warrants wide local excision with a 2 cm tumour-free zone. 2. Borderline malignant phyllodes tumours should be treated via simple mastectomy. 3. Axillary dissection is recommended only if nodes are palpable. 4. Adjuvant radiation is necessary, if wide local spread of the tumour is present and a resection of the lesion with a 2 cm tumour-free zone is not possible. Close follow-up is mandatory.