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There is a debate in the literature as to whether employee selection is a substitute or complement to incentive contracting. We argue that incentive contracts and selection can be both complements and substitutes conditional on the contracting difficulty faced by the firm. We examine these control choices in a setting where contracting difficulties arise due to the firm's choice of strategy and from the volatility created by the firm's external environment. We select a firm's commitment to organizational learning (OL) as our strategic choice variable as this provides a useful proxy for identifying settings where explicit incentive contracting is difficult. The results show that, as firms become increasingly committed to OL, incentive contracts and employee selection operate as complements. However, with a high commitment to OL and an increasing level of external volatility, contracting on performance measures will become less effective. In this context, our results indicate that there is a substitution effect toward employee selection.

This study examines factors influencing the difficulty of self-set goals and performance in a setting where employees were able to choose their performance goal from a menu of three choices established by management. Rewards for goal attainment were increasing in the difficulty of the goal. We develop a behavioral model of the factors expected to affect employees’ goal choices and performance. Anticipated influences on goal difficulty include employees’ impression management intentions, past performance, experience, and prior eligibility for rewards. We also expect performance to be related to goal difficulty. We use a unique combination of archival and questionnaire data from 476 employees at several call centers of a financial services company to test our hypotheses. All predictions are supported: the difficulty of self-set goals is negatively associated with employees’ impression management intentions; employees with better past performance set more difficult goals; and both prior performance and goal difficulty are positively associated with current period performance. We conduct supplementary analysis examining the extent to which employees selected attainable goals and the impact this had on performance. We also analyze the extent to which ratcheting concerns may have influenced actual performance for those employees who attained their goal. Implications for future research and practice are discussed.

This study closes the circle on a series of studies which have examined cross-cultural differences in the likelihood of sharing information in a situation where an error has been made. Building on the work of Chow et al. (1999), Chow et al. (2000), Salter and Schulz (2005), and Salter et al. (2008) it seeks to control for collectivism and test the effect of face by using nations that are quite similar in terms of collectivism, but at opposite ends of the face dimension. It finds that Chinese managers are less willing to share negative information when the supervisor is present than Chilean managers. Once the supervisor is removed there is no significant difference in the information sharing pattern of these two cultures. We attribute the results to the effect of “face” in the Chinese culture, which suppresses information sharing willingness in Chinese managers when the supervisor is present and is not a facet of the Chilean culture.

One of the biggest assets of a firm is its information base. Included in this information base is a knowledge of prior errors and failures. Extant research suggests that while the propensity to share “bad news” (i.e. a prior error) is dependent on the cost of sharing, the perceived value of that cost may be culturally dependent. One area of interest that has received substantial attention in the prior literature has been cross-cultural differences in negative information sharing in general, as well as the particular context in which the individual's superior is either present or absent during the information-sharing process. Our study examines the role of the two cultural values (individualism/collectivism and to a lesser extent power distance) in explaining national differences in information sharing. By focusing on a sample from Chile and Australia, we were able to remove the regional cultural dimension of face, which has been inherent in prior studies that used Greater China as the representative of a collectivist society. Results from our quasi experiment show that when a supervisor is present during information sharing, collectivist Chilean decision-makers are more willing to share negative information with their colleagues than their counterpart and individualist Australian decision-makers. Our results also show that when a supervisor is absent, both Australian and Chilean decision-makers are willing to share more negative information but the increase in the Australian propensity is significantly greater than that of the Chileans.

Improvements in the life expectancy of women with breast cancer raise important questions how to improve quality of life (QoL) for women sustaining complications and side effects of cancer treatment. The presented study examined the prevalence of arm morbidity in a cohort of primary breast cancer patients over time as a result of the extent of axillary lymph node dissection. Of particular interest is the question of using a recognized QoL assessment instrument at defined assessment points as an endpoint criteria of oncological treatment.A prospective, population-based, longitudinal cohort study of patients with primary breast cancer was performed (n = 389). QoL data (EORTC QLQ C30 + BR23) and clinical data were assessed at designated time points. Primary endpoint of this analysis was patient reported arm morbidity assessed with the three-idem scale in the BR 23 (swelling, moving, pain).20% of the patients evidenced considerable impairments in arm functioning. Arm morbidity was significantly related to the number of lymph nodes dissected (P0.002 entire cohort, P0.001 lymph node negatives) and was independent of age, stage of the disease, kind of breast surgery and radiation treatment. Early impairments in arm functioning (below 50 score values) assessed within 6 months after axillary surgery was a good predictor for late arm morbidity at 12 months RR 11.5 (CI 95% 4.7-28.4), 24 months RR 6.0 (CI95% 2.8-13.3) and 36 months RR 3.8 (CI 95% 1.8-7.9).Arm morbidity after axillary surgery is a severe and chronic condition affecting many breast cancer patients. The recognized QoL assessment instrument depict patients with severe impairments in arm functioning after axillary lymph node dissection and predict late arm morbidity. To increase patients' quality of life it thus may serve as a valid assessment tool for screening, allowing early referral for treatment and monitoring.

This paper proposes that a strong ethical environment will be effective in reducing the tendency for managers to continue failing projects in both the presence and absence of agency problems. The findings support these propositions, with a strong ethical environment found to significantly reduce managers' tendency to continue failing projects. Also, while agency problem effects were still present under a strong ethical environment, their impact was similar to the case of a weak ethical environment in the absence of agency problems. These findings suggest that creating a strong ethical environment may be a highly desirable control option for organizations generally.

This study proposes that organizations should consider project hurdle rates, as part of their control system design, to reduce escalation of commitment behavior in managers. In particular, we empirically examined the escalation of commitment tendencies in managers receiving organization-set, self-set, and no hurdle rates.Consistent with prior expectations, we found self-set hurdle rates to be an effective control mechanism resulting in significantly lower levels of escalation of commitment. Contrary to expectations, however, organization-set hurdle rates were not effective. Self-set hurdle rates also resulted in significantly higher cut-off rates compared to the average return of the investment portfolio held by the managers.As escalation of commitment has been recognized as a serious potential problem in organizations, the use of self-set hurdle rates is a step toward reducing the level of escalation tendencies in managers.

This cross-sectional study updated age changes for ultrasonometry (QUS) of the os calcis in a large sample of healthy German women. The speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI) of the os calcaneus were measured in 5148 women (mean age 55.2 ± 10.6 yr) using the Achilles ultrasonometer (GE/Lunar). There was an overall decline of 16% for BUA, 4% for SOS, and 32% for SI between late adolescence and old age. In premenopausal women, BUA decreased only slightly (–2%), whereas postmenopausal women showed a significantly increased decline (–12%). In contrast, SOS continuously decreased from the age of 15; there was a decline of 2% from adolescence to menopause. The SI of premenopausal women decreased only by 9%, but the postmenopausal decline of almost 21% was significantly greater. In accordance to our previous report, the age regression for SI in the larger sample differed from the earlier sample, indicating an increased bone loss with aging after the menopause. The SI values in premenopausal German women were comparable to those for British and American women 20–50 yr of age. After age 50, the SI of German women was significantly 3–7% higher in comparison to the British and American reference population.

Die Osteoporose zahlt mit ca. 5–6 Mio. Betroffenen zu den haufigsten Erkrankungen der postmenopausalen Frau in Deutschland. Hierbei sind Gynakologen gemeinsam mit Orthopaden, Endokrinologen und Radiologen mit der Diagnostik der Erkrankung betraut. Neben Anamneseerhebung und korperlicher Untersuchung stehen mit den radiologischen osteodensitometrischen Verfahren sowie den Ultraschallverfahren eine Vielzahl von Methoden zur Verfugung, die in Bezug auf die Frakturpradiktion ebenburtig sind. Da ca. 80–90% der Osteoporosefalle der Frau durch den Abfall der ovariellen Ostrogenproduktion in der Postmenopause bedingt sind, fallt der Gynakologie die wichtigste Rolle bei der Osteoporosepravention zu, die bereits in der ersten Dekade nach der Menopause begonnen werden sollte. In Abhangigkeit vom individuellen Risikoprofil besteht die Moglichkeit einer Pravention/Therapie durch eine knochenstoffwechselgesunde Lebensfuhrung/Ernahrung, ggf. Kalzium und Vitamin-D-Supplementierung, der Einleitung einer Hormonersatztherapie bzw. einer Behandlung mit selektiven Ostrogenrezeptormodulatoren (SERM), Bisphosphonaten oder Fluoriden.

The multifactorial disease of osteoporosis is one of the most frequent diseases, affecting about 5 - 6 Mio. postmenopausal women in Germany, today. In spite of the introduction of new technologies of fracture risk assessment and new pharmacological opportunities the incidence of fracture is still increasing. Therefore, early identification of women at high risk as well as early and individualised preventive measures are essential in the prevention of osteoporosis. Changes of dietary habits as well as lifestyle including an increase in physical activity are of up most importance. In addition to Calcium and Vitamin D supplementation, hormone replacement therapy (HRT) is accepted as the first line and cost effective pharmacological treatment for the prevention of osteoporosis. Numerous cross sectional, case-control and prospective studies showing the effect of HRT on bone reabsorption and bone mineral density (BMD) have been published. HRT reduces bone turnover which is followed by an increase of BMD. A number of case-control and cohort studies as well as a few recent prospective studies have been investigating the effect of HRT on osteoporosis related fracture. These studies confirm that HRT leads to a significant decrease of osteoporosis related fracture (Hip fracture by > 25%). However, randomised, prospective studies are needed to underline the effect on osteoporosis related fracture. Although the effect of HRT on BMD is independent of both, the age at which treatment is started and the route of administration, a dose-response relation as well as a greater response in patients with a lower initial BMD has been reported. Since bone is lost rapidly when treatment is stopped, the duration of treatment is clinically important in evaluating the effect of HRT on BMD. Hereby, a duration of 10 years and more seems desirable. Since the ongoing controversial discussion on the duration dependent increase of the incidence of breast cancer and the discussion on secondary prevention of cardiovascular disease, any therapy decision must be individually evaluated. The following article gives a systematical review on the recent literature regarding the influence of HRT on BMD and osteoporosis related fracture.

Studies from six regions of Germany (Aachen (W1), Dresden (E1), Jena (E2), Marburg (W2), Munich (W3), and Stuttgart (C1)) have been compared to verify and assess the quality of healthcare using breast cancer as an example. All of the data collection was carried out in comprehensive cancer centres and is population-based, with the exception of C1. Classic prognostic factors and the initial treatment of 8661 women with breast cancer, diagnosed between 1996 and 1998, were examined. Primary therapy, breast conserving therapy (BCT), and the use of subsequent local radiation and/or systemic therapy (chemotherapy or hormonal therapy) were analysed. BCT was performed on 39.3–57.7% of patients. By pT-category, the proportion of BCT in the six regions were as follows: for pTis between 37.8 and 64.3%, for pT1 between 51.7 and 71.5%, for pT2 between 25.9 and 51.1%, for pT3 between 0 and 13.1% and for pT4 between 0 and 15.2%. Multivariate analyses, adjusted for age and biological factors, showed a significant influence of the treating hospital on the mastectomy rate. The use of radiotherapy after BCT (80%) was quite homogeneous in the six regions. The application of radiotherapy after mastectomy, however, varied between 10.4 and 32.2%. In all regions, for premenopausal patients, the use of adjuvant systemic therapy almost reflected the St. Gallen-Consensus recommendations. In contrast, post-menopausal women with positive lymph nodes were not always treated according to these standards. In all regions, age had an influence on the administration of treatment: elderly breast cancer patients received less BCT, less radiotherapy and less adjuvant therapy than recommended in the St. Gallen-Consensus. Feedback of the results was made available to each hospital, providing a comparative summary of patient care that could be used by the participating hospitals for self-assessment and quality-control.

Zusammenfassung Sowohl endogene als auch exogen zugefuhrte Hormone haben Auswirkungen auf die Gewebsdichte der weiblichen Brust und somit auf die Sensitivitat und Spezifitat der Mammographie. Bei intakter Ovarialfunktion sollte eine Mammographie daher in der Follikelphase durchgefuhrt werden. Auch eine postmenopausale Hormonersatztherapie beeinflusst die Gewebsdichte, insbesondere bei kontinuierlicher kombinierter Gabe von Ostrogenen und Gestagenen. Dagegen erhohen Tibolon und Antiostrogene die Gewebsdichte nicht. Da bislang nicht geklart ist, welchen Einfluss eine Verminderung der mammographischen Gewebsdichte auf das Brustkrebsrisiko hat, ist sie als Biomarker in der Pravention des Mammakarzinoms nicht geeignet. Bei der Krebsfruherkennung ist die individuelle endokrine Situation der Frau in die Bewertung der Befunde mit einzubeziehen. Unklare Befunde bedurfen der weiteren apparativen oder minimal invasiven Abklarung.

Objective: Reproductive factors such as parity and breast-feeding may be associated with low bone mass and osteoporotic fractures in later years. In this study, os calcis quantitative ultrasonometry was used to elucidate the relationship between parity, lactation and bone mass in postmenopausal women. Design: This was a comparison study using subsequent matched pairs analysis as well as multiple linear regression analysis. The study was carried out at five centers in Germany. The study included 2080 postmenopausal women (age (mean ± SD) 58.8 ± 8.2 years), who were attending for routine check-up and in whom diseases and drug treatments known to affect bone metabolism had been excluded. Methods and outcome measures: Women underwent quantitative ultrasonometry (QUS) measurement at the heel. Values of the ultrasonometry variables –speed of sound, broadband ultrasound attenuation and stiffness index –were calculated and compared for nulliparous and parous women and for women who had and had not breast-fed. Bec...

Zusammenfassung In der frauenspezifischen Gesundheitsversorgung in der Bundesrepublik Deutschland steht das Thema "Brustkrebs" an erster Stelle. Senkung der Sterblichkeit bei Brustkrebs, die Verbesserung der Heilungschancen unter Erhalt der Lebensqualitat fur betroffene Frauen sind das definierte Gesundheitsziel. Erreicht werden kann dies durch eine qualifizierte, flachendeckende, fach- und sektorubergreifende leitlinienkonforme Ausgestaltung der 3 Saulen der Versorgungskette: sekundare Pravention, Therapie und tertiare Pravention. Funf Masnahmen umfassen heute die zielorientierte, regelmasige Tumornachsorge: Fruherkennung von lokal, lokoregionarem und kontralateralen Rezidiven, Kontrolle und Verbesserung der Therapiefolgestorungen Psychologische Betreuung, Beistand zur optimalen Gesundung, Lebensqualitat und Selbstbestimmung. Eine dauerhafte und zeitnahe Verbesserung einer an der Lebensqualitat der Patienten orientierten Versorgungsstruktur ist dabei masgeblich an die positive Bereitschaft der zielorientierten Forderung durch die Kostentrager gebunden.

Zusammenfassung Die Osteoporose zahlt mit 5–6 Mio. Betroffenen zu den haufigsten Erkrankungen der postmenopausalen Frau in der BRD. Mit osteodensitometrischen Verfahren wie der dualen Rontgenabsorptiometrie (DXA), der quantitativen Computertomographie (QCT) sowie der quantitativen Ultrasonometrie (QUS) stehen verschiedene Methoden zur Verfugung, die in Bezug auf die Frakturpradiktion ebenburtig sind. In ca. 80–90% ist die Osteoporose durch den physiologischen Abfall der ovariellen Ostrogenproduktion in der Postmenopause bedingt. Da der Knochenmasseverlust im ersten Jahrzehnt nach der Menopause am starksten ausgepragt ist, sollte bereits zu diesem Zeitpunkt mit der Osteoporoseprophylaxe begonnen werden. Durch gezielte Diagnostik kann ein individuelles Risikoprofil erstellt werden. In Abhangigkeit der Untersuchungsergebnisse besteht dann die Moglichkeit einer Pravention oder Therapie. Neben einer knochenstoffwechselgesunden Lebensfuhrung und Ernahrung bestehen die Optionen einer Kalzium- und Vitamin-D-Substitution, der Einleitung einer Hormonersatztherapie bzw. einer Behandlung mit selektiven Ostradiolrezeptormodulatoren, Bisphosphonaten oder Fluoriden.

Grundlagen: Die vorliegende Studie wurde durchgefuhrt, um die Rate der falsch-negativen Befunde der ultraschallgestutzten Stanzbiopsie (CNB) zu erheben und zu untersuchen, inwieweit die immunhistochemische Analyse der falsch-negativen Stanzbiopsate mit dem Epithelial-Membrane-Antigen eine Hilfe bietet, Karzinomzellen zu detektieren.

Die multifaktorielle Erkrankung der Osteoporose zahlt heute zu den haufigsten Erkrankungen der postmenopausalen Frau und weist trotz eines erweiterten Spektrums diagnostischer und therapeutischer Moglichkeiten weiterhin eine zunehmende Inzidenz auf. Die Osteodensitometrie ist inzwischen die anerkannte Methode zur Beurteilung des individuellen Frakturrisikos und klinisch unerlasslich im Rahmen einer Osteoporosediagnostik. Die radiologischen Verfahren wie die duale Rontgenabsorptiometrie (DXA) und die quantitative Computertomographie (QCT) sind den Ultraschallverfahren, wie die quantitative Ultrasonometrie (QUS), in Bezug auf die Frakturpradiktion ebenburtig. Die Messwerte der Osteodensitometrie werden nicht mehr in Prozenten angegeben, da diese zwischen den einzelnen Verfahren nicht vergleichbar sind, sondern als T- oder Z-Werte. Die Methoden korrelieren untereinander im Mittel zu ca. 70 %. Dabei ist jedoch die Hohe der Korrelation fur den einzelnen Patienten unerheblich. Hier ist es vielmehr entscheidend, diskrepante bzw. konkordante Werte fur den Patienten im Sinne der Fragestellung richtig zu interpretieren. Diskrepanzen zwischen zwei Messungen beim gleichen Patienten entstehen durch Fehlinterpretation der Messwerte verschiedener Methoden, die durch die Variabilitat der Anteile von Kompakta und Spongiosa im menschlichen Skelett an unterschiedlichen Messstellen und den unterschiedlichen Einflussen von Messtechnologie und Biologie bedingt sind.

Objective: Quantitative ultrasonometry is a radiation-free, low-cost, simple, quick and mobile method to evaluate properties of bone. The objective of this study was to evaluate the effectiveness, reliability and age-related findings of this technique in women and to establish a reference database. Methods: In a cross-sectional study we measured speed of sound, broadband ultrasound attenuation and the stiffness index of the calcaneus in 2272 women (mean age, 53.0 ± 10.5 years) with an ultrasound bone densitometer. Women with a history of osteoporosis, osteoporosis-related fractures or those using medications known to affect bone metabolism were excluded. In 791 women both calcanei were studied. Results: The short-term precision in vivo, expressed as coefficient of variance, was 1.2% for broadband attenuation, 0.2% for speed of sound, and 1.3% for stiffness. In women in whom both calcanei were studied the coefficient of correlation was 0.92 for speed of sound (p

Die Publikationen der Danish Breast Cancer Cooperative Group und die Ergebnisse des British Columbia Trial haben zu erheblichem Diskussionsbedarf uber den Stellenwert der Strahlentherapie nach Mastektomie gefuhrt. Ganz unterschiedliche Vorgehensweisen findet man selbst innerhalb derselben Tumorzentren. Die Deutsche Gesellschaft fur Senologie, in der alle medizinischen Bereiche auf dem Gebiet des Mammakarzinoms interdisziplinar kooperieren, hat deshalb eine gemeinschaftliche Stellungnahme erarbeitet. Material und Methode: Als Beratungsgrundlage dienten aktuelle Literaturmitteilungen und Expertenmeinungen, insbesondere die seit 1997 publizierten randomisierten Studien, ds weiteren Metaanalysen der Early Breast Cancer Trialists' Collaborative Group, epidemiologische Untersuchungen zum zeitlichen Verlauf von Fernmetastasen beim Mammakarzinom sowie die aktuelle Konsensbildung der American Society for Therapeutic Radiology and Oncology. Ergebnisse des Konsens: 1. Die optimale Durchfuhrung der Mastektomie ist eine wichtige Voraussetzung fur die Tumorheilung. Dabei sind sowohl eine R0-Resektion des Tumors als auch eine Entfernung von zumindest zehn Lymphknoten aus Level I und II der Axilla anzustreben. Bei axillarem Lymphknotenbefall stellt die operative Entfernung der Achsellymphknoten nicht nur eine diagnostische, sondern auch therapeutische Masnahme dar, indem damit das Risiko fur ein lokoregionares Rezidiv vermindert wird. 2. Lokoregionare Rezidive sind wahrscheinlich nicht nur Indikator, sondern auch Quelle fur das Auftreten von Fernmetastasen. 3. Die Bestrahlung der Brustwand und der Lymphabflusswege erhoht bei Risikopatientinnen die Heilungswahrscheinlichkeit und vermindert das Risiko eines lokoregionaren Rezidivs. Sie verbessert auch bei Resttumor oder inkompletter Achselausraumung die Prognose. Gesicherte Indikationen zur postoperativen Radiotherapie nach Mastektomie sind: T3/T4-Karzinome, T2-Karzinome mit einer Grose > 3cm, multizentrisches Tumorwachstum Lymphangiosis carcinomatosa oder Gefaseinbruche, Befall der Pektoralisfaszie oder Sicherheitsabstand < 5mm, R1- oder R2-Resektion, mehr als drei befallene Achsellymphknoten. Als sinnvolle, aber noch nicht in klinischen Studien evaluierte Indikationen gelten: Multifokalitat, extensive intraduktale Komponente, Rezeptornegativitat, Malignitatsgrad G3, diffuse Mikrokalzifikationen, ein bis drei axillare Lymphknotenmetastasen. Zustand nach mehreren, nicht in sano erfolgten Biopsien. Alter unter 35 Jahre. 4. Eine simultan zur Radiotherapie durchgefuhrte Tamoxifenbehandlung ist entgegen teilweise anderslautenden In-vitro-Daten durchaus sinnvoll, zumal Tamoxifen die Apoptose fordert. Eine CMF-Therapie wird ublicherweise im Sandwich-Verfahren durchgefuhrt, kann jedoch in begrundeten Fallen auch simultan zur Strahlentherapie erfolgen. Eine anthrazyklinhaltige Chemotherapie sollte hingegen vor Beginn der postoperativen Radiotherapie abgeschlossen sein. Schlussfolgerungen: Die adjuvante Radiotherapie nach Mastektomie verbessert zumindest bei Risikopatientinnen die Zehn-Jahres-Uberlebenswahrscheinlichkeit um bis zu 10%. Die Hypothesen von Halsted und Fisher schliesen sich gegenseitig keineswegs aus. Es gibt Patientinnen, bei denen eher die eine, und solche, fur die eher die andere Hypothese Gultigkeit hat.

This study aimed to evaluate the influence of hormone replacement therapy (HRT), the estradiol concentration and body mass index (BMI, kg/m(2)) on the serum leptin concentration in postmenopausal women.352 healthy postmenopausal women (mean age, 60.9 +/- 8.5 years) participated in this comparative study. 71 (30%) women (mean age 55.9 +/- 8.3 years) had taken HRT, while 281 (70%) women (mean age, 59.1 +/- 10.6 years) had not. Baseline characteristics -age, weight, height, BMI (greater than or = 25 or25), follicle stimulating hormone, estradiol, and leptin values-were compared in the two groups. In a second analysis to evaluate the influence of HRT, estradiol concentrations, and BMI on leptin concentrations, these data were analysed in women allocated to one of four groups: (a) postmenopausal women not on HRT with a BMI25 (n = 130); (b) postmenopausal women not on HRT with a BMI greater than or = 25 (n = 151); (c) postmenopausal women on HRT with a BMI25 (n = 48); and (d) postmenopausal women on HRT with a BMI greater than or = 25 (n = 23). Leptin concentrations were subsequently analysed in relation to BMI and age and BMI and estradiol concentrations to determine any independent effect of these variables.The women taking HRT had a significantly lower mean age, weight, BMI and follicle stimulating hormone concentration than those who were not taking HRT. Furthermore, they had a higher mean height and serum estradiol value, but a significantly lower serum leptin concentration. After controlling for BMI, neither the use of HRT nor the estradiol concentration was found to be related to the leptin value (group (a) versus (c) and group (b) versus (d)), but there were significant differences in leptin concentrations between HRT users with BMI greater than or = 25 and BMI25 and between women not taking HRT with BMI greater than or = 25 and BMI25 (groups (a) versus (b) and (c) versus (d)). Furthermore, women with a BMI greater than or = 25 had significantly higher leptin concentrations than women with a BMI25, irrespective of the HRT use.Leptin concentrations are significantly higher in obese postmenopausal women than in their non-obese counterparts. Serum leptin concentrations are not influenced by HRT use or estradiol concentrations. Further studies are needed to elucidate the role of HRT and estrogen on serum leptin concentrations.

Die Hormonersatztherapie (HRT) fuhrt bis zu einer Anwendungsdauer von 5 Jahren zu keiner Erhohung des Mammakarzinomrisikos. Langere Therapiezeiten erhohen das Risiko geringgradig. Obwohl der Nutzen einer langfristigen HRT nach dem derzeitigen Kenntisstand uberwiegt, muss dieser Faktor im Rahmen der Aufklarung der Patientinnen berucksichtigt werden. Nach der Therapie des Mammakarzinoms gilt die HRT als grundsatzlich kontraindiziert. Im Individualfall kann sie jedoch nach Ausschopffung der Alternativen eingesetzt werden. In der Praxis betrifft dies vorwiegend die Gruppe von Patientinnen, die massiv unter den vegetativen und vasomotorischen Symptomen des Ostrogenentzugs leiden. In dieser Situation sind nicht-hormonale Alternativen meist wenig wirksam.

This study was undertaken to evaluate the impact of hormone replacement therapy on results of quantitative ultrasonometry of the heel.A total of 2006 healthy perimenopausal women (mean age, 52.2 (10.3 years) were recruited in 5 German centers: 611 women (30%) had received hormone replacement therapy and 1395 (70%) had not. About 90% of the hormone replacement therapy users were current users, and the rest had stopped6 months before the study. Speed of sound, broadband ultrasonographic attenuation, and the stiffness index were compared among the following groups: all users and nonusers of hormone replacement therapy, hormone replacement therapy users and nonuser control subjects matched for age and body mass index, and hormone replacement therapy users grouped in relation to the duration of hormone replacement therapy use and age and control subjects matched for body mass index.Women who were using hormone replacement therapy had significantly higher values (P.001) than did nonusers for all ultrasonographic variables, even after we controlled for age and body mass index. Women who had used hormone replacement therapy for3 years had significantly higher values (P.001) than did matched control subjects for all variables. Differences increased with the duration of hormone replacement therapy use.Quantitative ultrasonometric measurement at the heel differentiates hormone replacement therapy users from nonusers, reflects duration of hormone replacement therapy use, and could be useful in both clinical trials and patient management.

Objective To investigate whether imprint cytology of core needle biopsy (CNB) specimens from breast lesions is a useful method of rapidly obtaining additional diagnostic information and potentially can be used to reduce the number of biopsies needed. Study design Cytologic analysis was performed on 173 breast lesions and compared with their histopathologic diagnoses (143 malignant and 30 benign). For imprint cytology, one CNB specimen was rolled between two slides and stained with Diff-Quik and Papanicolaou stain. Results The diagnostic overall accuracy of Diff-Quik stain (Papanicolaou stain) was 95.4% (95.9%), with a sensitivity of 96.5% (97.2%), specificity of 90% (90%), positive predictive value of 97.8% (97.8%) and negative predictive value of 84.3% (87.0%). There was no statistically significant difference between the stains. Histopathologic analysis had an overall accuracy of 97.7%, with a sensitivity of 97.2%, specificity and positive predictive value of 100% and a negative predictive value of 88.2%. Conclusion Imprint cytology of CNBs is a sensitive method of detecting malignancies in breast tumors. Diff-Quik is a rapid and reliable approach that can reduce the number of biopsies. Inadequate and suspicious cases should be evaluated based on complementary diagnostic procedures for breast lesions.

Observers of the modern business environment have emphasized that if management accounting is to remain relevant to the realities of the 1990s and beyond, it has to evolve beyond the traditional “gathering, assimilating and reporting function” to encompass the processes whereby information reaches managers. The objective of this teaching case is to assist extending management accounting coverage towards this process. In both Australia and Taiwan, we have successfully used this case to supplement text and end-of-chapter materials at both the advanced undergraduate and graduate levels. The similarity of our teaching experiences between Australia and Taiwan, in conjunction with the generic nature of the case, suggest that it can be used in other national contexts with little or no modification.

Objective: Because estrogens are important in the pathogenesis of both breast cancer and osteoporosis, it has been suggested that the risk of osteoporosis and breast cancer are inversely related. The aim of our study was to evaluate bone mineral density in patients with breast cancer. Methods: Speed of sound, broadband ultrasound attenuation, and the stiffness index of the calcaneus were measured in 1004 subjects (mean age 53.9 years) with an Achilles ultrasound bone densitometer. 148 patients had a history of breast cancer and 856 did not. Breast cancer patients were compared with healthy subjects matched for age, weight, body mass index (BMI), parity, and duration of breast feeding and estrogen exposure. Results: Overall, the patients with breast cancer were 4.4 years older and had higher body weight, BMI and parity, longer duration of breast feeding and estrogen exposure, and a significantly higher speed of sound and stiffness index than healthy controls. In the matched-pairs analysis, women with breast cancer had a higher speed of sound and stiffness index than the controls. Conclusion: Women with breast cancer have a lower risk of osteoporosis than controls. Although the biologic mechanisms linking bone mass and the risk of breast cancer are not fully understood, factors other than cumulative estrogen exposure may play a role. Studies on larger populations are needed to evaluate this relationship.

Objectives: To compare a composite ultrasonometry variable, the stiffness index (SI), with its two component variables of speed of sound (SOS) and broadband ultrasound attenuation (BUA), in identifying post-menopausal women with low bone mineral density (BMD) and/or osteoporotic fracture. Methods: A cross sectional sample of 1217 women (mean (S.D.) age 53.9 (9.7) years) was studied. Risk factors for osteoporosis were assessed by detailed questionnaire and women with diseases, or those taking treatments known to affect bone metabolism were excluded. Women were allocated to one of four groups: pre-menopausal women (n=476), healthy post-menopausal women (n=583), post-menopausal women with low BMD (n=101), and post-menopausal women with osteoporotic fracture (n=57). An Achilles ultrasonometer was used to perform quantitative ultrasonometry (QUS) at the os calcis. The SI, calculated mathematically from SOS and BUA, was computed. Results: Analysis of receiver operating curves (ROC) between healthy post-menopausal women and post-menopausal women with low BMD but no fracture, showed that the area under the curve (AUC) for SI was significantly greater than that for BUA (P

Purpose: This cross-sectional study collected data on the effectiveness, validity and reliability of QUS. Method and Material: Speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) of the calcaneus were measured in n = 764 postmenopausal patients, mean age 61 years, using the Achilles ultrasound bone densitometer (Lunar Corp., Madison, WI). In addition we measured blood levels of E2 and FSH in 157 patients and correlated these variables with data gathered by a detailed questionnaire. Women using any medication known to effect bone metabolism were excluded from the study. Results: The Achilles shortterm precision in vivo expressed as coefficient of variance was 1.2 % for BUA and 0.17% for SOS and 1.3% for stiffness respectively. A total of 102 women were measured at the right and left calcaneus with a coefficient of correlation of r= 0.92 for SOS, r = 0.84 for BUA and r = 0.93 for SI. Cross-sectional analysis showed a significant yearly postmenopausal decrease of 0.06% for SOS, 0.44% for BUA and 0.74% for SI. Women with a history of osteoporosis (165 patients) as well as 141 women with an osteoporosis-related fracture showed significantly lower results in all ultrasound parameters (SOS, BUA, SI). In conclusion, quantitative ultrasound osteodensitometry of the calcaneus measures properties of bone which continue to decline with age. The low precision error and the high correlation of right vs. left underlines the high technical standard. Conclusion: Our results indicate that QUS is capable of identifying in a precise manner women with previous osteoporotic fractures as well as women with a history of osteoporosis. Hence, QUS may provide a radiation-free, low-cost, easy to handle, fast and mobile method which for the first time could make a screening programme a feasible proposition.

Die hormonelle Substitutionstherapie bringt neben der Behandlung klimakterischer Beschwerden auch einen Benefit fur kardiovaskulare Erkrankungen und Osteoporose. Es existieren aber auch potentielle Risiken. Diese betreffen insbesondere aus Patientinnensicht die Entwicklung von Malignomen. Hier werden die Risiken bezuglich der Entwicklung von Mamma- und Genitalkarzinomen diskutiert. Zusatzlich wird auf die Moglichkeit einer hormonellen Substitutionstherapie nach Behandlung eines Mamma- oder Genitalkarzinomes eingegangen. Zervixkarzinom: Keine Risiken, keine Kontraindikation. Ovarialkarzinom: Ein protektiver Effekt bei der Langzeiteinnahme hormoneller Kontrazeptiva ist gesichert. Fur die Substitutionstherapie konnte das jedoch nicht bestatigt werden. Andererseits erscheint das Risiko einer Malignomentstehung aber auch nicht anzusteigen. Eine Kontraindikation nach Behandlung besteht nicht. Endometriumkarzinom: Hochdosiert und alleinige Ostrogengaben fuhren dosis- und zeitabhangig zu einem 2– bis 20–fach hoherem Risiko an einem Malignom des Endometriums zu erkranken. Durch mindestens 10–tagige zusatzliche Gestagengaben last sich diese Ostrogenwirkung aufheben. Die kombinierte Substitutionstherapie fuhrt sogar zur Minderung des Endometriumkarzinomrisikos im Vergleich zu unbehandelten Frauen. Das behandelte Endometriumkarzinom wird nicht mehr als uneingeschrankte Kontraindikation angesehen. Mammakarzinom: Die Diskussion um eine potentielle Erhohung des Erkrankungsrisikos wird seit vielen Jahren kontrovers gefuhrt. Nach dem derzeitigen Kenntnisstand ist eine hormonelle Substitutions- therapie mit einer Dauer von bis zu 5 Jahren nicht mit einer Erhohung des Mammakarzinomrisikos verbunden. Ein geringer Anstieg last sich dagegen bei Langzeittherapie (> 10 Jahre) nicht ausschliesen. Bestimmte Risikogruppen existieren nach derzeitigem Kenntnisstand nicht. Das behandelte Mammakarzinom gilt als klassische Kontraindikation gegen den Einsatz einer hormonellen Substitutionstherapie. Dies wird heute von vielen als nicht mehr haltbar angesehen. Andererseits liegen keine Daten groseren Umfangs vor, die die Sicherheit einer hormonellen Substitutionstherapie nach Mammakarzinom belegen.

During the last two decades, considerable experimental evidence has been collected indicating that epithelial ovarian cancer might be gonadotropin dependent. LH and FSH receptors have been described in some of these tumors. The proliferation of ovarian cancer cells could be stimulated in vitro by gonadotropins. Suppression of endogenous LH and FSH secretion by GnRH-agonist treatment inhibited the growth of experimental or heterotransplanted ovarian cancers in various animal models. A number of recent phase II clinical trials have shown that the application of GnRH-agonists can lead to remission or stable disease in patients with relapsed advanced ovarian cancer. At present, prospective controlled clinical studies are being performed to assess the efficacy of GnRH-agonist treatment in addition to conventional surgical and cytostatic therapy in ovarian cancer in FIGO stages III and IV. Also, direct effects of GnRH analogues on ovarian cancer seem possible: a GnRH-like protein has been found in the human ovary. Our group discovered and partially characterized a specific GnRH-binding site (mol. wt 63.2 kDa) in ovarian cancer which is very similar to other human extrapituitary GnRH-binding sites of the low affinity, high capacity type, e.g. in breast cancer or the placenta. Recently, other groups have described also high affinity GnRH-agonist binding sites in ovarian cancer as well as in other extrapituitary tissues. First results from our laboratory indicate that the proliferation of certain ovarian cancer cell lines in vitro is reduced by both agonistic and antagonistic analogues of GnRH. Other authors were able to inhibit gonadotropin-induced in vitro proliferation of ovarian cancer cell lines by co-incubation with a GnRH-agonist.(ABSTRACT TRUNCATED AT 250 WORDS)

In this study, we examine two factors that impact managers' willingness to share private information during the project review stage of capital budgeting. Drawing on the cognitive dissonance theory and the agency theory, we find that both high perceived personal responsibility and the use of project reviews for performance evaluation result in a greater tendency for managers to withhold negative private information. However, we do not find an interaction between these two factors. Our study makes a contribution to both the academic literature investigating factors affecting project reviews and the practitioner literature looking at design and implementation of effective project reviews. © 2009 AFAANZ.

Using survey and archival data from 598 employees of a Fortune 100 financial services firm, this paper studies the antecedents and consequences of using goal selection as an impression management tool. We find that poor performance relative to performance targets in one period increased employees' desire to use goal setting as an impression management tactic in the next period. In addition, using goal setting as an impression management tactic causes employees to self-select less difficult performance goals, which in turn negatively impacts actual performance. Given the extensive use of goal setting in organizations, understanding its use and effects as an impression management tactic is important.

The administration of GnRH analogues is expected to improve treatment by avoiding hysterectomy, since problems connected with the surgical removal of leiomyomata are correlated with their size. In this study the GnRH analogue goserelin in its depot formulation (Zoladex, ICI, Plankstadt) was used for treating isolated leiomyomata of the uterus. All patients were treated for 3 months before myomectomy was performed. The complete regression of a large myoma (206 cm3) was observed in 1 of 11 patients. In 5 cases a reduction in volume of more than 50% was achieved. Ovarian function was suppressed by goserelin, after a short-term stimulation, within 7 +/- 3 days. Serum levels of 17 beta-oestradiol were found to be generally less than 25 pg/ml. All patients reported climacteric complaints, but in no case had therapy to be discontinued. After cessation of goserelin, restoration of ovarian function was observed in all patients.

In the current environment, an important firm asset is the employee knowledge base, which in a large part depends on employee willingness to share information. Yet prior research has noted that while employees are delighted to reveal success they are often reluctant to reveal errors. While there are many factors affecting managers’ reluctance to reveal errors, this study focuses on cultural differences between Chinese migrants and Anglo residents as well as the role of acculturation. This is particularly relevant given the very significant foreign direct investment into China, and migration of managers and high-end technical staff from portions of Greater China to the management and higher technical classes of the Anglo world. Prior studies including Chow, Harrison, McKinnon, and Wu (1999a). Accounting, Organizations and Society, 24, 561–582, Chow, Deng, and Ho (2000). Journal of Management Accounting Research, 12, 65–95, and Tinsley and Pillutla (1998). Journal of International Business Studies, 29(4), 711–728, provide conflicting views and evidence for differences in information sharing between Chinese and Anglo managers, and there is no accounting or management literature that deals with changes in information sharing behavior in the migration process. This study employs an experiment to test for differences in individuals’ willingness to share information about a prior costing error. Using a sample of students from two different nationalities drawn from a major Australian university (Australian and Hong Kong SAR, China), this study finds that migrant Chinese share less information than Anglo-Australians. This study further provides empirical evidence that the relative change in willingness to share this information when the supervisor is removed from the decision context is lower for the migrant Chinese than for the Anglo-Australians. Finally, this study finds evidence for acculturation as the willingness of migrant Chinese managers changes with the length of their stay in the new society. Acculturation occurs relatively quickly and highly acculturated Chinese information-sharing behavior is not significantly different from the Australian-born subjects.

The present analysis focuses on the long term psychological reactions to early stage breast cancer. Two hypotheses were formulated. The first hypothesis draws a direct link between tumour size/survival chances and Quality of life (QoL): The better the survival chances, the better QoL ('biological danger model'). The second hypothesis assumes that localized early breast cancer has excellent prognosis (90% five year survival rate), and that therefore QoL differences between various forms of early breast cancer should be minimal ('medico-pragmatic model').In a defined rural area with 252.000 inhabitants (small-area-analysis), a total of n = 389 patients with primary breast cancer were recruited. For the present analysis we selected a subgroup (n = 269) from the cohort by tumour size (pTis, pT1a,b, pT1c, and pT2). QoL scores for global quality of life, emotional functioning and future perspective were computed according to the EORTC manual and compared to age-matched norm data of the German population.A total of 690 QoL questionnaires were obtained from n = 269 patients with comparable completion rates within the four subgroups (pTis, pT1a,b, pT1c, and pT2). For all four groups and in all scores there were improvements over time. Generally, pTis always scored highest, pT2 always lowest, the other two groups in between. After one year pTis patients had higher mean scores in global quality of life than the norm. In contrast, pT1a,b were considerably lower than the norm and the difference between these two was 17.2 score points. It seems that the small difference (3.5%) in five year survival chances between pTis and T1 a,b tumours transforms into marked differences regarding quality of life, thus supporting a biological danger model of the survival/QoL relationship.Our results show that physicians have to realise although their early breast cancer patients have excellent survival chances, psychological distress is present. From a clinical perspective we would recommend that early stage breast cancer patients, and especially patients with occult, pT1a,b tumours be informed about their excellent prognosis. In addition, cognitive therapy might help patients stop worrying about their cancer.

Objective The goal of this work was to study the anticancer activity of cetrorelix, a decapeptide with LHRH receptor antagonist properties in patients with platinum-resistant ovarian cancer. About 80% of primary ovarian cancers and cell lines bear LHRH receptors. Cetrorelix has anticancer activity in in vitro and in vivo ovarian cancer models. Methods Eligible patients with ovarian or mullerian carcinoma resistant to platinum chemotherapy received cetrorelix 10 mg subcutaneously every day. Eligibility criteria included age ≥ 18, PS ≤ 2, measurable disease, chemistries and blood counts in normal range, no estrogen replacement for at least 2 weeks, and no known allergic reactions to extrinsic peptide. In patients volunteering for a biopsy, tissue was taken to perform a LHRH receptor assay. Results Seventeen patients were treated. Median age was 58 years. Median performance status was 0. Median number of prior chemotherapies was 3. Three patients had partial remissions lasting 9, 16, and 17 weeks. Toxicities effects included grade 4 anaphylactoid reaction (one patient) controlled by cortisol and cimetidine, grade 2 histamine reaction (two patients), grade 2 arthralgia (one patient) 20% cholesterol increase (two patients, who did not require specific treatment), minor hot flushes, headache, and local skin reaction at the injection site. Six of seven samples were LHRH receptor positive for mRNA and/or ligand assay. Two responding patients were LHRH receptor positive. The patient who had no receptor did not respond. Conclusion Cetrorelix has activity against ovarian cancer in this refractory population, and has minimal toxicity, except for potential anaphylactoid reactions. Activity may be mediated through the LHRH receptor.

Clinical breast examination (CBE) refers to the traditional technique of physical examination of the breast by a health care provider. The examination comprises both systematic inspection and palpation of the nipple, breast, and lymph-draining regions in the axillae and supraclavicular and infraclavicular fossae. CBE is the least studied of the modalities for breast cancer screening. Whereas recommendations for mammography and breast self-examination (BSE) can be based on the findings of randomized screening trials, there have been no randomized trials of CBE alone on which to base recommendations. However, there is considerable indirect evidence from studies that CBE can be recommended as a method for detecting breast cancer for public health benefit. The examination by itself is inexpensive, as no special equipment is required. It is easy to perform, it can be readily taught to health care providers, and it can be offered ubiquitously. CBE should be part of any program for early detection of breast cancer worldwide, provided that follow-up medical and oncology care is available. Physicians and women should be informed about the advantages and disadvantages of this modality, especially as there are no data from randomized trials about the contribution of CBE in detecting breast cancer at an early stage and the absolute benefit of this modality in reducing breast cancer mortality and improving quality of life. Further research on CBE should be promoted, especially in countries with limited resources, to evaluate its efficacy and effectiveness in relation to age, ethnicity, and race.

The present study investigates the population of beta 2-receptors on lymphocytes in pregnant women with premature labor between the 29th and 34th week of pregnancy. The population of receptors on lymphocytes correlates with that on the myometrium, which is not accessible for study during pregnancy. Fourteen patients received a pulsatile tocolysis, while ten women received a continuous tocolysis with Fenoterol. Assuming an equal population of receptors in both groups before commencement of therapy, the numbers of receptors in the patients with continuous tocolysis fell to about 35% of the initial value after 72 hours. Under pulsatile tocolysis, the numbers of receptors remained unchanged for a period of three days and was still only just below 70% of the initial value by the seventh day. Our data demonstrate that continuous administration of the short-acting beta 2-agonist Fenoterol resulted in a substantial loss of beta 2-adrenoceptors on lymphocytes. In contrast, intermittent administration of the same beta 2-adrenergic agonist prevented the onset of receptor down-regulation in pregnant women with preterm labor. Further studies are required to investigate the impact of the decreased loss of beta 2-adrenoceptor density on the good clinical experience with intermittent tocolysis.

the aim of this study was to evaluate the influence of serum leptin concentration on bone mass assessed by quantitative ultrasound (QUS) in a large sample of healthy pre and postmenopausal women.555 healthy pre and postmenopausal (n=261 and n=294) women (mean age, 49.5+/-17.2 years) not on hormone replacement therapy were recruited on the occasion of a routine gynecological visit. Before entry to the study, all women had answered a detailed questionnaire on important risk factors and gave written informed consent. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) of the os Calcis were measured using the Achilles ultrasonometer (GE/lunar). We systematically investigated the relation of menopause, BMI and leptin on bone mass by allocating women into the following groups: (a) premenopausal women BMI25 kg/m(2) (N=178); (b) premenopausal women BMI25 kg/m(2) (N=83); (c) postmenopausal women BMI25 kg/m(2) (N=125); and (d) postmenopausal women BMI25 kg/m(2) (N=169). Additionally we investigated the relation of serum leptin concentrations, age and BMI on ultrasonometry variables by performing a multiple linear regression analyses.in the initial analyses premenopausal women showed a significantly (P0.001) lower mean age, weight, BMI, follicle stimulating hormone (FSH) and leptin concentration, a higher mean height, serum estradiol and ultrasonometry variables in comparison to postmenopausal women. Irrespective of the menopausal status, women with a BMI25 kg/m(2) had significantly higher leptin concentrations (P0.001) and BUA (P0.05) whereas SOS and SI was not significant different, compared to women with a BMI25 kg/m(2). The multiple linear regression analyses showed that only BMI but not Leptin was related to higher ultrasonometry variables, whereas increasing age was associated with a decrease in ultrasonometry variables. Furthermore, the multiple linear regression analyses confirmed that age and BMI were the only statistically significant independent predictor for ultrasonometry variables. There was no significant influence of leptin on ultrasonometry variables even after controlling for BMI or age, or BMI and age.serum leptin concentrations are significantly higher in pre and postmenopausal obese women, compared with normal weight controls. Ultrasonometry variables are influenced by age and BMI but not by serum leptin concentrations.

OBJECTIVE: The aim of this study was to evaluate the influence of menopausal status, serum estradiol and body mass index (BMI) on serum leptin concentration in a large sample of pre- and postmenopausal women. DESIGN: 434 healthy women (mean age +/-s.d., 52.2 +/- 10.3 years) were recruited at the University of Marburg on the occasion of a routine gynecological visit. Two hundred and eighteen (50.2%) women were premenopausal (mean age, 36.5 +/- 10.4 years) and not on oral contraceptives or hormone replacement therapy (HRT) and 216 (49.8%) women were postmenopausal (mean age 61.8 +/- 8.9 years) not on HRT. To evaluate the influence of menopausal status, estradiol level and BMI on serum leptin concentrations, women were allocated to one of the four groups: (a) premenopausal women BMI 25 kg/m(2) (n=81), (c) postmenopausal women BMI 25 kg/m(2) (n=122). RESULTS: Irrespective of the menopausal status, women with a BMI >25 kg/m(2) had significantly higher leptin concentrations in all age groups compared with women with a BMI

OBJECTIVE: To evaluate the impact of long-term, non-suppressive levothyroxine (L-T(4)) treatment on quantitative ultrasonometry in women. DESIGN: This was a case-control study. SUBJECTS AND METHODS: Altogether 667 women (mean age+/-s.d., 49.5+/-13.1 years) were studied. Of these, 156 (23%) had non-toxic goitre or hypothyroidism and had been taking L-T(4) (75-100 microg/day) for at least 5 years (mean+/-s.d., 12.5+/-7.5 years); the remaining 511 (77%) women were not receiving L-T(4). All women had completed a questionnaire on risk factors for thyroid dysfunction and osteoporosis, and those with diseases or treatments known to effect bone metabolism - other than thyroxine or hormone replacement therapy (HRT) - were excluded. Women underwent quantitative ultrasonometry (QUS) at the heel. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (SI) were compared, first, in all women taking L-T(4) and controls and, secondly, in women taking L-T(4) and controls pair-matched for age, weight, body mass index (BMI), menopausal status and HRT use. RESULTS: Even after matching for age, weight, BMI, menopausal and HRT status, women taking L-T(4) had significantly lower values for SOS and SI (P

This study assessed age changes in quantitative ultrasound sonometry (QUS) in a large sample of healthy German women. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI) of the calcaneus were measured in 1333 women (mean age 50.5 +/- 11.5 years) using the Achilles ultrasonometer (Lunar Corp., Madison, WI, USA). The short-term precision in 31 adults was 0.2% for SOS, 1. 2% for BUA, and 1.3% for SI. There was an overall decline of 15% for BUA, 4% for SOS, and 31% for SI between late adolescence and old age. In premenopausal women, BUA decreased only slightly (-3%), whereas postmenopausal women showed a significantly increased decline (-12%). In contrast, SOS continuously decreased from the age of 15; there was a decline of 2% from adolescence to the menopause; postmenopausal women showed a slightly larger decline (-2.5%). The SI of premenopausal women decreased by 10%, but the postmenopausal decline of almost 22% was significantly greater. SI values for premenopausal German women were comparable to those observed in the American Achilles reference population, but postmenopausal German women had significantly higher SI values of 7% due to a lower rate of aging loss.

Obwohl s-Mimetika derzeit die effektivsten Medikamente zur Unterdruckung vorzeitiger Wehen sind, ist der Nutzen der Therapie, sowie Dauer und Wahl des Zeitpunkts in der Schwangerschaft Gegenstand der Diskussion. Ziel unserer Studie war es, anhand objektivierbarer Kriterien eine optimale tokolytische Therapie unter gleichzeitiger Minimierung der mutterlichen Nebenwirkungen zu erreichen. Der Angriffspunkt der eingesetzten s-Mimetika ist der s-2-Rezeptor am Uterus. Dieser ist zwar in der Schwangerschaft nicht untersuchbar, jedoch steht uns mit den s-Rezeptoren auf Lymphozyten im peripheren Blut ein beobachtbares Modell zur Verfugung, das ausreichend Ruckschlusse auf die Vorgange am Uterus selbst erlaubt.

Die ovariellen Steroide Ostradiol (E) und Progesteron (P) sind potente Modulatoren der GnRH-induzierten Gonadotropinsekretion. Jungere Untersuchungen habengezeigt, das die Steriodeffekte uber einen Einflus auf das GnRH-Signaltransduktionssysthem vermittelt werden konnen. (1). Der Anstieg der intrazellularen Ca2+-Konzentration nach Agonist-Stimulation der gonadotropinen Zellen gilt als der zentrale Signaltransduktionsmechanismus (3). Wir gingen der FRagen anch, ob die modulatorischen Effekte von E und P uber eine Wirkung der Steriode auf den Ca2+-Influx durch Spannungsabhangige Ca2+-Kanale (VSCC) in die Hypophysenzelle vermittelt werden konnen.

Laboruntersuchungen sind fester diagnostischer Bestandteil bei der Uberwachung von Tumorpatienten (1, 2, 3). Die vorliegende Studie untersucht die Wertigkeit der etablierten biochemischen Laborparameter (Tumormarker, BSG, Leberenzyme, alk. Phosphatase) fur die Fruherkennung einer Metastasierung beim Mammakarzinom.

Die zunehmenden Anforderungen an Dokumentation, Statistik und Leistungserfassung ganz allgemein lassen in der Medizin den Einsatz der EDV primar sinnvoll erscheinen. Leider sind es oft unausgereifte Programme, die eher den Anforderungen der Verwaltung als den Notwendigkeiten des klinischen Alltags entsprechen, die zur groser Frustration beim Einsatz des Computer fuhren. Auf der Basis der seit vielen Jahren eingefuhrten EDV-Dokumentation im OP ensteht derzeit in Marburg ein Software-Paket, das die Routinearbeiten auf unseren operativen Stationen erleichtern soll.

Die operative Therapie des Mammakarzinoms hat sich in den letzten zehn Jahren entscheidend gewandelt. Die Ergebnisse internationaler und deutscher Therapiestudien (1, 2, 3) zeigten deutlich, das eingeschrankt operative Behandlungsverfahren unter Beachtung bestimmter operativer und patho-histologischer Kriterien radikal operativen Masnahmen im Bereich der weiblichen Brust nicht unterlegen sind. Sogenannte brusterhaltende Operationsverfahren stellen somit in Kombination mit einer unabdingbaren postoperativen Nachbestrahlung der Brust eine feste Grose im Rahmen der Mammachirurgie dar. Es ergeben sich jedoch in einer Vielzahl der Falle Kontraindikationen zur brusterhaltenden Behandlung und zwar nicht nur auf der Basis tumorbiologischer und patho-histologischer Befunde, sondern vielmehr existieren auch relevante Kontraindikationen aus rein kosmetischer Sicht. Bei einem Tumorsitz im oberen inneren oder unteren inneren Qudranten der Brust wird in vielen Fallen bei ausreichender Resektion des Tumors im Gesunden der Parenchymdefekt so gros, das es in Folge zur Deformation der Brust kommt. Im Falle einer ausgesprochenen Makromastie lassen sich zwar grose Substanzdefekte operativ ohne Probleme beseitigen, jedoch ruckt hier die strahlentherapeutische Problematik der homogenen Dosisverteilung bei grosem Brustvolumen in den Vordergrund. In der vorliegenden Studie wurde nun versucht durch besondere Schnittfiguren in den oben gennanten beiden Situationen ein brusterhaltendes Operationsverfahren moglich zu machen.

Wesentlicher Bestandteil prognostischer Aussagen und therapeutischer Entscheidungen in der gynakologischen Onkologie waren und sind die klinischen Befunde, sowie verschiedene makroskopische und mikroskopische Kriterien der untersuchten Tumoren. Sie stellen jedoch nur Momentaufnahmen eines sehr komplexen Krankheitsverlaufes dar. Momentaufnahmen konnen jedoch immer nur ein sehr grobes Raster fur die tatsachliche Einschatzung individuellen Tumorwachstums liefern. Therapeutische und prognostische Fehlentscheidungen ergeben sich zwangslaufig. Neue Wege resultieren aus der Erkenntnis, das proliferationskontrollierende Signale im gesunden Gewebe, aber auch in Malignomen einer Rezeptorvermittlung bedurfen. Inzwischen wissen wir, das auch andere humorale Einflusse, ebenso wie Zell-Zell-Interaktionen und von der Tumorzelle selbst gebildete Regulatoren nur uber entsprechende Rezeptoren wirksam werden konnen. Die routinemasige Bestimmung verschiedener Rezeptoren im Tumorgewebe wurde zum Hoffnungstrager fur eine therapie-relevante Definitionsmoglichkeit individueller Wachstumscharakteristika unterschiedlicher Krebsformen. Die nachfolgenden Ausfuhrungen sollen eine kritische Analyse dieses Konzeptes auf der Basis neuerer tumorbiologischer Erkenntnisse darstellen.