Usage trends of minimally absorbed vaginal estrogens in breast cancer patients versus patients with non-breast malignancies

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Background: To determine if differences exist in the use of minimally absorbed vaginal estrogens in a breast cancer population versus one with non-breast malignancies. Methods: A retrospective review of all patients with documented malignancy who were prescribed vaginal 17-β-estradiol tablets (Vagifem, Novo-Disc, Princeton, New Jersey) through the General Gynecology Service from July 1, 2003 to June 30, 2004. Data were accessed from the pharmacy health information computerized system. All patients complained of dyspareunia, and examination was consistent with vaginal atrophy. Comparison between groups was performed using the Fisher Exact Test and t-test. Results: 152 patients were identified_81 patients with breast cancer diagnoses and 71 with non-breast malignancies. There was no difference in the mean age of patients in either group, 56.9 vs. 55.1 years. (p = 0.30). Overall, 60 of the 152 patients refilled their prescriptions through the time of last follow-up. There was no difference in the proportion of breast versus non-breast cancer patients who continued vaginal estradiol, 39.5% (32/81) versus 39.4% (28/71) respectively. When the cohorts were stratified by age ≤ 50 or >50 at the time of initial consultation, 79% (11/14) of breast cancer patients age ≤ 50 years refilled their prescriptions at follow-up compared to 31.3% (21/67) of patients >50 (p = 0.002). In women with non-breast malignancies there was no age-related difference in the proportion who obtained refills: 35% (7/20) ≤ 50 years versus 41.2 % (21/51) >50 years (p = 0.79). Conclusions: Minimally absorbed vaginal estrogens appear to be viewed favorably amongst the younger breast cancer patient population. The older breast cancer population does not appear to continue vaginal estradiol use long-term. This may be due to differences in relationship status, interval from menopause to diagnosis, prior exposure to estrogen, or relief of symptoms with alternative therapies. These findings are different than those observed for similar patients with non-breast malignancies. Further studies looking at the use of minimally absorbed vaginal estrogens are needed to further evaluate the usage trends in differing patient populations.

No significant financial relationships to disclose.

Mammalian PASKIN, a PAS-serine/threonine kinase related to bacterial oxygen sensors

The PAS domain is a versatile protein fold found in many archaeal, bacterial, and plant proteins capable of sensing environmental changes in light intensity, oxygen concentration, and redox potentials. The oxygen sensor FixL from Rhizobium species contains a heme-bearing PAS domain and a histidine kinase domain that couples sensing to signaling. We identified a novel mammalian PAS protein (PASKIN) containing a domain architecture resembling FixL. PASKIN is encoded by an evolutionarily conserved single-copy gene which is ubiquitously expressed. The human PASKIN and mouse Paskin genes show a conserved intron-exon structure and share their promoter regions with another ubiquitously expressed gene that encodes a regulator of protein phosphatase-1. The 144-kDa PASKIN protein contains a PAS region homologous to the FixL PAS domain and a serine/threonine kinase domain which might be involved in signaling. Thus, PASKIN is likely to function as a mammalian PAS sensor protein.

[Olfactory and gustatory sweating--case report on reflex facial hyperhidrosis]

Localised hyperhidrosis is comparatively rare among the vegetative disorders. A case of pathological gustatory and olfactory sudation is reported, with the sequence of symptoms corresponding to that of the Frey syndrome. Working from the reflex nature of the phenomen, the paper puts forward a model to account for the delayed onset of the manifestation following a peripheral lesion. It is assumed that readjustment of the reflex excitation level takes place according to a modification in peripheral afference, and that a decompensation of the central control mechanisms results in a pathological enhancement of the reflex. The hypothesis of peripheral efferentisl denervation hypersensitivity appears insufficient to account for the delay in manifestation, or even to account for the classic Frey syndrome following an affection of the parotid gland.

[The portal system and the hepatic artery in children with extrahepatic bile duct atresia. 2: Further duplex sonography parameters and flowmetry]

Since 1 1/2 year we performed duplex-sonographic examinations including flowmetry of the portal system and hepatic artery in children with biliary atresia. In children with hepatofugal collaterals we found a significant decreased Time Average Velocity (TAV) with 0.09 m/s against the control group with TAV of 0.18 m/s. The TAV in the splenic vein was also decreased. In the hepatic artery we found no change of the TAV. In most of the children a portal hypertension with hepatofugal collaterals was to be found in the first year of life. In 14 children the collaterals were visible. In these 14 children and 7 other children calculated parameters indicated the very high probability of collateral vessels. In children with hepatofugal collaterals we found a decreased portal vein flow. In 16 of 21 cases the flow in the hepatic artery was increased.

[The portal system and hepatic artery in children with biliary atresia. 1: Ultrasound and simple duplex ultrasound parameters]

In 37 children with extrahepatic biliary atresia between 12 days in 9 years of age we performed 72 duplexsonographic examinations of the portal system and the hepatic artery. In the control group we investigated 61 healthy children. All investigations were performed with computer sonography (Acuson 128) with a 3.5 MHz and 5 MHz-Transducer. We described changes of sonographic parameters such as hepatic structure, liver and splenic size. In 14 children with extrahepatic biliary atresia hepatofugal collaterals were visible. Specially in patients with collaterals we found changes of vessel diameters. The maximal flow velocity of the portal vein was significantly decreased in patients with extrahepatic biliary atresia.

[Systemic salmonella infections in chemotherapy in 2 children with acute lymphoblastic leukemia]

A 15 year old patient with acute lymphoblastic leukemia, previously diagnosed as being a salmonella carrier, developed S. typhimurium sepsis after allogeneic bone marrow transplantation, in spite of pretreatment with chloramphenicol. Clinical improvement and termination of salmonella excretion were achieved by treatment with multiple antibiotics. Another patient with acute lymphoblastic leukemia, a 3 year old boy not previously identified as a salmonella carrier, also developed sepsis and osteomyelitis, together with pathological fractures during chemotherapy. Chloramphenicol, administered after isolation of S. typhimurium from blood cultures, led to resolution of the bony defects, complete recovery, and cessation of salmonella excretion. Selective cultures for salmonellae seem indicated in patients with malignant diseases, prior to chemotherapy.

[Sonography of the larynx in childhood: new perspectives due to the use of computerized sonography. 1: Anatomy and method]

We report on new perspectives in diagnostic ultrasound of the larynx, which has become possible by applications of computer sonography. To our knowledge no such comprehensive ultrasonic diagnostics in children are reported as yet in the area of larynx. All examinations were performed with a computed sonography system (Acuson 128). We used a linear transducer with a penetration corresponding to 5 MHz an a resolution corresponding to 10 MHz. The frame rate was around 25 Hz and thus enabled a good reproduction of dynamic processes. As we could show, it is possible to visualize all significant structures of the larynx including the thyroid cartilage, the vocal ligament, the vocalis muscle, the arytenoid cartilage and the piriform fossa. Of course the vestibular fold and the cervical musculature are also demonstrable. The high frame rate of the instrument anaibled a good reproduction of dynamic processes. The sonographic demonstration of anatomical structures is possible as well as a functional diagnosis.

[Sonography of the larynx in children. New perspectives due to the use of computerized sonography: 2: Sonographic findings in a case of laryngeal papillomatosis]

On our opinion one important indication for sonographic diagnosis in future are masses in the larynx area: in infancy or childhood mainly laryngeal papillomatosis. In one of our boy patients with massive laryngeal papillomatosis laser surgery was first performed at 15 months of age. After a second and third procedure interferon-therapy was begun. Sonographically it was easily possible to follow the course in control examinations. Sonographic findings correlated well with laryngoscopic findings. Laryngoscopy could therefore be limited to a minimum.

[Ultrasound diagnosis of the larynx with the aid of computerized sonography]

We report on new perspectives in diagnostic ultrasound of the larynx, a method that has become possible by the application of computed sonography. The examinations were performed by means of a computer sonography system (Acuson 128). For all investigations we used a 5 MHz linear transducer with a resolution corresponding to 10 MHz. The frame rate was between 20 Hz and 50 Hz and thus enabled good reproduction of dynamic processes. We could show that it is possible to visualize all significant structures of the larynx including the thyroid cartilage, the vocal ligament, the vocalis muscle, the arytenoid cartilage and the piriform fossa. With sufficient practice, good demonstration and hence assessment of the larynx can be already possible in infancy. We examined children and adults between 6 days and 35 years of age. - Masses in the laryngeal area are among the important indications for sonographic diagnosis: in infancy and childhood, these are mainly represented by laryngeal papillomatosis. In one of our patients suffering from massive laryngeal papillomatosis, laser surgery was first performed when he was 15 months of age. After a third removal procedure, interferon therapy was initiated. Sonographically it was easily possible to follow the course. Sonographic findings correlated well with laryngoscopic findings. Laryngoscopy could therefore be restricted to a minimum.

T-cell acute childhood lymphoblastic leukemia with chromosome 14 q 11 anomaly: a morphologic, immunologic, and cytogenetic analysis of 10 patients

Ten patients with T-cell acute lymphoblastic leukemia (ALL) and a chromosome anomaly involving band 14 q 11 are described. Mitotic index of bone marrow blasts was high in all patients (average 3.0%). Lymphoid morphology of the leukemic blasts, however, varied somewhat among the patients. The leukemic cells of 5 patients showed an immunophenotypic profile corresponding to early or common thymic differentiation stages whereas 5 children showed strong expression of CD 3 suggesting a more mature thymic phenotype. Leukemic karyotypes revealed a modal chromosome number of 46 in 9 cases, 92 in one case. A chromosome translocation t(11; 14) (p 13; q 11) was found in 5 cases, a t(1; 14) (p 32; q 11) in 2 cases, a t(10; 14) (q 24; q 11) in one case, a (hitherto undescribed) t(12; 14) (q 22; q 11) in one case, and an inv (14) (q 11 q 32) in one patient. Additional abnormalities were t(3; 10), t(7; 9), dup(7 q), del(6 q), del(10 q), and del(1 q). Of 32 cases with T-cell ALL successfully karyotyped in our laboratory 15 (= 47%) had structural aberrations involving chromosomes 1, 3, 6, 7, 9, 10, 12, 14. Ten of these 15 patients (= 67%) had a chromosome 14 q 11 anomaly. It is concluded that chromosome band 14 q 11, the gene locus of the T-cell receptor alpha-chain, is the most common site for structural chromosome aberrations in T-cell ALL.

[Pubertas praecox in McCune-Albright syndrome--case report and review of the literature]

A patient is presented with the syndrome of polyostatic fibrous dysplasia and precocious puberty (PP). The endocrinopathy in McCune-Albright-syndrome (MAS) has formerly been ascribed to a central (hypothalamic) origin. In this patient the PP was caused by a luteinized follicular cyst, suggesting autonomous hyperfunction of this gland. High serum estradiol levels returned to normal after cystectomie. The review of the literature suggests the peripheral origin of PP to be more frequent in younger age groups (under 6 years). It appears possible that peripheral hypersecretion of sexual steroids may cause a rise of gonadotropins secondarily followed by true PP in older children provided such longstanding hypersecretion leads to a generalized maturation of the body including skeletal maturation. Treatment in pseudoprecocious puberty seems to be not effective with LH-RH-analogues. Cyproteroneacetate alone or in combination with a LH-RH analogue gave the impression of being more successful. Cystectomy can lead to a cure but a recurrence of ovarian cysts is possible. A combination of surgical and drug therapy may be beneficial under these circumstances. Until now there is no sufficient treatment for polyostotic fibrous dysplasia.