The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer

BACKGROUND

Having demonstrated in a previous report that the response of circulating epithelial tumor cells (CETC) during the first cycles of primary (neoadjuvant) chemotherapy perfectly reflects the response of the tumor, in the present study the changes in cell numbers during subsequent cycles and their possible impact on the therapy's outcome were examined.

PATIENTS AND METHODS

In 58 breast cancer patients CETC were quantified during therapy with either EC (epirubicin/ cyclophosphamid) or dose intensified E (epirubicin) followed by taxane, with or without trastuzumab, and subsequent CMF (cyclophosphamid/methorexate/ fluorouracil).

RESULTS

CETC numbers declined more than 10-fold (good response) in 65% (her2/neu-negative) and 55% (her2/neu-positive) of patients during EC, and in 60% during dose intensified E, respectively, followed by an increase of CETC in all patients. CETC remained increased, decreasing only when adding CMF. A good initial response correlated with estrogen-receptor negativity, a poor response with early distant relapse (P < 0,0001, hazard ratio = 11.91).

CONCLUSION

Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumor. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumor-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.

Myocardial injury due to lightning

The report deals with a 27-year-old male who was standing in a tent and was injured by lightning as it struck a tree about 1.5 m away. He immediately lost consciousness and exhibited ventricular fibrillation when the emergency physician arrived. A clinical picture of hypoxaemic brain damage emerged after initially successful resuscitation. Brain death was diagnosed on the fifth day after injury. The discrete external findings (remaining arborescent skin marks) contrasted markedly with the severe thermal damage to the pectoral muscle and cardiac musculature found during the autopsy. The histological cardiac findings indicated severe acute myocardial infarction affecting virtually all parts of the myocardium.

Comparison of eye protection with methylcellulose an paraffin ointments during general anaesthesia

A total of 120 patients who were all anaesthetized for more than 90 minutes were given eye protection with paraffin-based oculentum simplex, Ph. Nord. 63, in one eye, and water-based four per cent methylcellulose in the other. Anaesthesia was conducted with halothane, or thiopentone an meperidine, or by a neurolept technique. Peri-ocular oedema and reaction in the conjunctiva resembling conjunctivitis was less pronounced after methylcellulose. When both paraffin-based ointment and halothane anaesthesia were used, there were signs of drug interaction, as the patients' conjunctivae were now distinctly red. In all three types of anaesthesia, methylcellulose produces a firm gluing of the eyelids with the result that the eye is not dried out and the eye is protected mechanically so that foreign bodies and corneal abrasions are avoided. There were no untoward effects of methylcellulose. It is concluded that methylcellulose four per cent provides better eye protection than paraffin during general anaesthesia.

Fibromuscular dysplasia of coronary arteries as a rare cause of death

A case of fibromuscular dysplasia of the coronary arteries in a 15-year-old boy is reported. After a quarrel involving no violence the boy suddenly suffered from ventricular fibrillation, collapsed and was initially successfully defibrillated. After 37 days of deep unconsciousness the boy died of bronchopneumonia. The cause of the ventricular fibrillation was clarified only after histological investigations. Fibromuscular dysplasia of the coronary arteries with narrowing was found, which has very occasionally been described in the literature. However, its localization in the A-V node artery, as described here, only seems to have been observed once.

High Oleic Sunflower: Studies on Composition and Desaturation of Acyl Groups in Different Lipids and Organs

A selection of lipids from achenes, cotyledons after germination, roots and leaves of normal and high oleic varieties of sunflower were analyzed with regard to their fatty acid profiles. The lipids included triacylglycerol and phosphatidylcholine as ER-made components and mono-and digalactosyl diacylglycerol as plastid-localized glycolipids. A comparison of fatty acid pat­ terns showed that the block in oleate desaturation of the high oleic variety is confined to the ER of fat accumulating embryos, but that upon germination the oleate desaturation in the cotyledonary ER is rapidly derepressed. These data are supported by enzymatic experiments. In microsomes from maturing fruits of the high oleic variety oleoyl-phosphatidylcholine desaturase could not be detected, whereas o leoyl-CoA : lyso-phosphatidylcholine acyltransferase and components of the microsomal electron transport chains were not affected. A correlation in the expression of desaturation blocks in seed and root fatty acids as observed in mutants of other species was not observed which, therefore, cannot be generalized. Our data are discussed in terms of the existence of two ER-specific oleate desaturase activities.

Comparison of Phosphoenolpyruvate-Carboxykinase from Autotrophically and Heterotrophically Grown Euglena and Its Role during Dark Anaerobiosis

Euglena gracilis (1224-5/9) contains phosphoenolpyruvate carboxykinase when grown autotrophic with CO(2) in the light. Its yield is higher when an additional carbon source like glucose has been added. The enzyme is lacking in cells provided with CO(2) alone and kept in the dark, whereas highest yields result if both glucose and CO(2) are provided together in the dark. The enzyme was purified by ammonium sulfate precipitation, gel filtration on Sephacryl S-300 and affinity chromatography on GMP-Sepharose. The latter step was most effective to protect the enzyme from inactivation. Its homogeneity was tested electrophoretically and immunologically. Enzymes from autotrophic and heterotrophically grown cells have identical pH optima and similar isoelectric points. The molecular weight was different: 761,000 for the enzyme from autotrophic and 550,000 for that from heterotrophic cells as determined by gel filtration. The subunit molecular weight of both enzymes is nearly the same. The kinetic data of the enzymes are slightly different. Glycolytic and tricarboxylic acid cycle intermediates are of limited influence on enzyme activity and inhibitory in unphysiological high concentrations. From Ouchterlony double immunodiffusion and enzyme-linked immunosorbent assay, it is evident that the enzyme is localized in the cytosol. With the latter quantification test the phosphoenolpyruvate carboxykinase protein content was found 10 times higher in heterotrophically grown cells than when cultivated under autotrophic conditions.

Biosynthesis and desaturation of prokaryotic galactolipids in leaves and isolated chloroplasts from spinach

Mono- and digalactosyldiacylglycerol (MGDG and DGDG) were isolated from the leaves of sixteen 16:3 plants. In all of these plant species, the sn-2 position of MGDG was more enriched in C(16) fatty acids than sn-2 of DGDG. The molar ratios of prokaryotic MGDG to prokaryotic DGDG ranged from 4 to 10. This suggests that 16:3 plants synthesize more prokaryotic MGDG than prokaryotic DGDG. In the 16:3 plant Spinacia oleracea L. (spinach), the formation of prokaryotic galactolipids was studied both in vivo and in vitro. In intact spinach leaves as well as in chloroplasts isolated from these leaves, radioactivity from [1-(14)C]acetate accumulated 10 times faster in MGDG than in DGDG. After 2 hours of incorporation, most labeled galactolipids from leaves and all labeled galactolipids from isolated chloroplasts were in the prokaryotic configuration. Both in vivo and in vitro, the desaturation of labeled palmitate and oleate to trienoic fatty acids was higher in MGDG than in DGDG. In leaves, palmitate at the sn-2 position was desaturated in MGDG but not in DGDG. In isolated chloroplasts, palmitate at sn-2 similarly was desaturated only in MGDG, but palmitate and oleate at the sn-1 position were desaturated in MGDG as well as in DGDG. Apparently, palmitate desaturase reacts with sn-1 palmitate in either galactolipid, but does not react with the sn-2 fatty acid of DGDG. These results demonstrate that isolated spinach chloroplasts can synthesize and desaturate prokaryotic MGDG and DGDG. The finally accumulating molecular species, MGDG(18:3/16:3) and DGDG(18:3/16:0), are made by the chloroplasts in proportions similar to those found in leaves.

Distinction between forensic evidence and dermatological findings

The external examination after death requires knowledge in forensics/pathology, dermatology, as well as associated diseases and age-related alterations of the skin. This article highlights some findings with forensic evidence versus dermatological findings. The lectures in forensic medicine should be structured interdisciplinarily, especially to dermatology, internal medicine, surgery, pathology, and toxicology in order to train the overlapping skills required for external and internal postmortem examinations.

Cystic fibrosis in 65- and 67-year-old siblings. Clinical feature and nasal potential difference measurement in patients with genotypes F508del and 2789+5G-->A

Cystic fibrosis (CF) is a recessive genetic disease caused by defects of the cystic fibrosis trans-membrane regulator (CFTR) gene with a median survival of less than 35 years. This work reports on the oldest living German siblings with CF. Besides clinical history, CF genotype and nasal potential difference (NPD) measurement results, the remarkably high exercise activity of the siblings is discussed as a disease-modifying factor. Both male patients have an overall mild pulmonary manifestation. They have suffered from abdominal symptoms since their early childhood, including recurrent pancreatitis and diffuse symptoms leading to partial gastric resection. They were diagnosed as having CF with positive sweat tests at the advanced ages of 45 and 43 years, respectively. Later on genotyping revealed compound heterozygosity for F508del and 2789+5G-->A. Using NPD we demonstrated a CF-typical inhibition of the NPD by the Na channel blocker amiloride, although in both siblings the remaining CFTR function and alternate chloride channel function were detected during superfusion of the nasal epithelium with isoproterenol and ATP. Long-term survival with CF is basically influenced by the CFTR genotype. The patients' genotype was discussed as a mild one with remaining CFTR function. We demonstrated this residual CFTR function in both siblings using NPD. Additionally the siblings' continuous healthy lifestyle and their engagement in a remarkably high level of exercise activities from early childhood to the present possibly have an important effect on the long-term outcome of CF as disease-modifying factors. In this regard this report can encourage CF patients to maintain a high level of physical activity in their daily lives.

[Synovial chondromatosis of the temporomandibular joint--a differential diagnosis to parotid gland tumor]

Synovial chondromatosis of the temporomandibular joint is an uncommon disease of cartilaginous transformation of synovial membrane with formation of loose bodies within the joint space. The stimulus for synovial chondromatosis at this site is unknown. Symptoms frequently include pain and preauricular swelling with occasional snapping during jaw movements. Radiographs of the TMJ may be normal or show multiple, partially calcified loose bodies within the joint. Treatment consists of removal of the loose bodies together with all affected synovium. In this paper a case of synovial chondromatosis affecting the temporomandibular joint is reported and the literature of 38 cases is reviewed.

[Effect of diabetes mellitus on anterior central lens epithelium in cataract patients]

The relationship between diabetic metabolic disorder and the impairment of lens epithelium in the development of age-related cataract cannot be completely defined yet. In this prospective study, morphological criteria and the phosphorus content of the anterior central lens epithelium in type-II diabetics and nondiabetics are compared.

PATIENTS AND METHODS

Fifty-six of the overall 159 patients with age-related cataracts were suffering from type-II diabetes (group I) and 103 are nondiabetics (group II). In each case, a fragment of the anterior central lens epithelium was evaluated morphologically using a scanning electron microscope (S-2400) and examined by EDXA (X-ray spectrometer TN-5500), with regard to phosphorus content. The criteria considered were the degree of damage to the epithelium (score 1-3), the morphologically evaluated cell density and the "peak/background" relationship for phosphorus.

RESULTS

The mean degree of damage to the epithelium was 1.48 +/- 0.53 in the type-II diabetic group (I) and 1.55 +/- 0.65 in the nondiabetic group (II), respectively. The median cell density of type-II diabetics (group I) was 4838 +/- 1033 cells/mm2 compared with 5454 +/- 1368 cells/mm2 of the nondiabetics (group II). The mean "peak/background" relationship for phosphorus was 0.46 +/- 0.20 in group I and 0.51 +/- 0.26 in group II, respectively.

CONCLUSION

In the younger patients, the significant decrease in cell density and the increased degree of damage to the anterior central lens epithelium in the type-II diabetic group could be attributed to the cataractogenic influence of diabetic metabolic disorder on the lens epithelium. Another possible indication for that was the smaller phosphorus content in this group as evidence of the decrease in the biological activity of the cells (ATP-function). The primary cataractogenic importance of the lens epithelium in type-II diabetics could not be concluded.

Intravitreal Anti-Vascular Endothelial Growth Factor for Macular Edema due to Complex Retinal Arterial Macroaneurysms

Introduction

Complex retinal arterial macroaneurysms (RAM) are often accompanied by hemorrhage and/or affect the macula. We evaluated the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy using ranibizumab or aflibercept with or without laser photocoagulation in the treatment of macular edema due to RAM.

Methods

A case report of two patients with secondary macular edema caused by RAM is presented. The first case was a 76-year-old female treated with two 0.5-mg injections of ranibizumab and additional focal laser photocoagulation. This patient presented a solely intraretinal exudation. The second patient was a 96-year-old female, who received one 2.0-mg injection of aflibercept. She showed sub- and intraretinal edema. We documented the clinical courses of these patients based on fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography. Patients were followed-up for 12 months.

Results

Patients were treated successfully using anti-VEGF therapy (ranibizumab or aflibercept) with or without laser photocoagulation. In both cases, we observed a complete regression of the macular edema and an increase in visual acuity.

Conclusion

RAM can manifest with heterogeneous findings. Intravitreal anti-VEGF therapy with or without laser photocoagulation may be an effective treatment option in cases of macular edema due to RAM. Aflibercept and ranibizumab seem to be a potent anti-VEGF therapy for RAM. Individualized patient care is needed.

[Foreign body granuloma after lower eyelid avulsion and surgical revision with silicone tube splint]

BACKGROUND

Foreign-body-reactions with granulomas after use of silicone-containing biomaterials are of clinical importance [4].

HISTORY AND SIGNS

A 4-year old patient entered our hospital with a reddish vascularised tumor. The tumor's origin was in the conjunctiva of the nasal lid-angle of the right eye.

THERAPY AND OUTCOME

After a traumatic disconnection of the canaliculus lacrimalis inferior, a bicanalicular silicon-tube intubation had been performed with the patient in the age of one year. Only 3 years after this intervention a secondary clinical examination could be performed. At this time, an extended solid conjunctival-tumor appeared at the operated eye. After removal and histological examination it could be classified as a foreign body granuloma.

CONCLUSIONS

The blood- and tissue compatibility of silicone is only insufficiently guaranteed on the basis of the hydrophobic material-surface. After reconstructive lacrimal surgery postoperative care and the removal of the stabilizing silicone material is necessary.

[Autopsies for anatomical teaching and training in clinical forensic medicine]

BACKGROUND

Clinical forensic medicine does not only entail examination of patients after physical violence but also the option of clinical autopsies, e.g. after non-notifiable complications of medical interventions, after fatalities closely following medical interventions or fatalities as a result of injuries when the public prosecutor decides not to order a medicolegal autopsy. Based on this routine the Institute of Forensic Medicine at the University of Rostock offers a training course in topographical anatomy to physicians for further training in interventional and surgical disciplines.

METHODS

At the beginning of autopsies the participants can explore the approaches of interventional puncture techniques as well as surgical techniques and the basic topographical anatomy in small groups of 2-4 persons under the supervision of forensic examiners. The format is essentially oriented to the early further training period but fulfils the requirements for the exploration of complex operative techniques. The course was adapted for physicians and offered separately to students. The explorations are performed manually or by support with autopsy instruments.

RESULTS

The courses offer an ideal room for individual, discipline-specific topics and result in a great benefit for all participants. A statistical assessment can only be achieved with a larger number of participants.

CONCLUSION

Making autopsy rooms available for teaching and further training represents an additional feature to the profile of clinical forensic medicine. Lessons in topographical anatomy provide a great benefit for patient safety. It seems to be important to offer the opportunity to address individual interests in a closed meeting to consolidate skills and abilities in a non-judgemental environment. The post-mortem examiners have to ensure that the autopsy is carried out lege artis. Basic ethical principles and all regulations from an accredited scope have to be adhered to.

Behaviour and metastatic potential of her2/neu positive and her2/neu negative circulating epithelial tumor cells (CETC) during adjuvant systemic therapy in breast cancer

Abstract #5030

Background: Most tumor patients do not die from the primary tumor but from metastases in vital organs. Here we report on the influence of adjuvant chemotherapy and trastuzumab on the remnant CETC patients with her2/ positive tumors after surgery and the impact on metastasis formation.&#x2028; Material and Methods: Tumor cells were quantified with an automated microscope (Laser Scanning Cytometer®, Icis or ScanR) from anticoagulated blood drawn before each new therapy cycle from patients treated with systemic chemotherapy after surgery and subsequent maintenance therapy with trastuzumab. After red blood cell lysis leucocytes were stained with PE-anti-CD45 and tumor cells with FITC-anti-EpCAM. FISH analysis was performed for determination of the proportion of her2/neu positive cells and changes registered as % increase or decrease. The response to therapy was correlated to outcome.&#x2028; Results: Almost all her2/neu positive breast cancer patients scheduled for systemic treatment had CETC before therapy. A decrease in cell numbers highly correlated with relapse free survival. Her2/neu positive patients responding to therapy with an increase in CETC were at increased risk to develop further increasing cell numbers also during subsequent trastuzumab treatment. Her2/neu positive patients who did never receive trastuzumab all had increasing CETC numbers during the postoperative observation time and all have suffered relapse. Patients who received trastuzumab only after adjuvant treatment all had decreasing CETC numbers and all are in sustained complete remission after up to 4 years. Of the patients who received trastuzumab together with adjuvant treatment those who showed no change or an increase in CETC in spite of trastuzumab had increasing proportions of FISH high amplified cells and a higher risk of relapse than patients with decreasing CETC during trastuzumab.&#x2028; Discussion: Monitoring CETC will not only provide the earliest and most reliable indicator of successful adjuvant treatment and spare patients unnecessary treatment but also patients with the highly aggressive her2/neu positive tumors can be discerned into such with high and low risk of relapse even during trastuzumab therapy. This warrants further therapy studies to control what patients may benefit from addition of e.g. small molecules already during therapy before development of metastases.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5030.

EXPERIENCE WITH OCRIPLASMIN IN PATIENTS WITH VITREOMACULAR TRACTION SYNDROME: A RETROSPECTIVE STUDY OF 10 PATIENTS

PURPOSE

To assess the efficacy of ocriplasmin in patients with vitreomacular traction (VMT) syndrome <1,500 μm with or without a full-thickness macular holes of <400 μm.

METHODS

In this study, a retrospective analysis of 10 eyes of 10 patients with VMT who were treated with ocriplasmin between December 2014 and January 2016 was performed. Ocriplasmin 0.125 mg was injected only once in all cases. Outcome measures included the detachment of VMT, best-corrected visual acuity, the evaluation of optical coherence tomography, including the closure of full-thickness macular holes, and the reduction of macular edema (if present) and the decrease of metamorphopsia if present.

RESULTS

Ten patients (7 women and 3 men) with an average age of 75.1 years (range, 63-84 years) were treated with ocriplasmin with a follow-up period of 8 weeks. All patients were treated for VMT syndrome, and 5 patients (50.0%) showed an additional macular hole. An absolute detachment of VMT was seen in 3 patients (30.0%) and partially in 4 patients (40.0%). In three of the five patients, a complete closure of the full-thickness macular holes was seen. The two other patients needed an additional pars plana vitrectomy as a result of the persistent macular hole. An improvement of visual acuity was seen in 6 out of 10 patients (60.0%), a reduction of macular edema in 8 out of 9 patients (88.9%), and a decrease of metamorphopsia in 6 out of 7 patients (85.7%).

CONCLUSION

In this retrospective analysis, the treatment with ocriplasmin showed a resolution of VMT in 7 of 10 patients (70.0%) after a follow-up period of 8 weeks.