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Aim: Preoperative chemotherapy (PCT) is used in primary breast cancer, to facilitate breast conservative surgery (BCS). Clinical and pathologic responses are important prognostic parameters. Biologic markers are needed to individualize treatment., Patients and Methods: One hundred and thirty-five patients with breast carcinoma were treated with PCT, followed by surgery and adjuvant therapy. Clinical response and pathological complete response (pCR), biological markers and type of surgery were compared between invasive ductal (IDC) and invasive lobular carcinoma (ILC)., Results: Overall response (OR) for IDC was 75% compared to 50% for ILC (P=0.0151). Pathological CR was 15% for IDC and 0% for ILC (P=0.0066). Fifty-six percent of the responding patients had BCS, in contrast with 16% of the non-responders. BCS was performed in 50% of patients with IDC, in 38% of the patients with ILC. Salvage surgery was more necessary in ILC (19%) compared to IDC (4%) (P=0.0068). Patients with ILC were more frequently ER-positive and HER-2 negative than patients with IDC., Conclusions: Clinical and pathological responses are lower in ILC compared to IDC. After PCT, patients with large ILC should preferably be offered mastectomy with immediate breast reconstruction. However, PCT still remains valuable to evaluate tumor response and biologic factors in vivo.

Purpose: To identify the factors that influence analgesic consumption during SWL on the Dornier Lithotripter U/50., Patients and Methods: In Group 1 (N = 152), analgesia was induced with propofol 0.8 mg/kg and alfentanil 8 microg/kg. In Groups 2 (N = 78) and 3 (N = 250), the induction dose was reduced by 20%. For all patients, the maintenance dose was propofol 0.25 mg/kg and alfentanil 5 mg/kg administered with a patient-controlled analgesia (PCA) device. Groups 1 and 2 had SWL with the EMSE 220 shockwave emitter, whereas Group 3 was treated with the EMSE F150. Data were collected on treatment, total drug doses, and side effects., Results: There was no significant difference in PCA dose among the groups, but analgesic consumption was lower in patients treated with the EMSE F150. Except in Group 2, analgesic consumption tended to decrease with age until age <70. The 20% reduction in the induction dose did not cause an increase in PCA usage. Analgesic consumption was higher for kidney than for ureteral stones and was highest for stones in renal pelvis. Consumption was lower for larger stones than for smaller stones and higher for patients receiving more shockwaves. Almost one quarter of patients in Group 1 exhibited transient O2 desaturation during induction, an effect that was less common in the other groups. Ventricular premature beats were detected only during treatment of stones above the ureteropelvic junction., Conclusions: Intravenous administration of a combination of alfentanil and propofol via a PCA device is an elegant, reliable, and safe method of analgesosedation for SWL. Patient satisfaction is high, and side effects are uncommon. Faster turnover of patients is possible.

In an open-label Swiss multicentre trial to assess patient acceptance, efficacy and safety of zolmitriptan 2.5 mg tablets in the acute treatment of migraine, 112 patients were enrolled and 281 migraine attacks evaluated. Patients completed a specially designed protocol during and after each attack. Special attention was given to the patients' subjective comparison of the study drug with previously used abortive treatments. On this matter, zolmitriptan performed clearly better than analgesics and NSAIDS (78% "better"). Compared with sumatriptan, zolmitriptan was narrowly preferred (45% "better", 36% "worse"). Headache intensity was reduced from moderate or severe to mild or none after one hour in 51% and after 2 hours in 70%. Median time to efficacy was 50 minutes. Autonomic symptoms such as nausea and photo- and phonophobia were improved in 45 to 55%. A subjectively significant improvement in general condition (functionality) was reported in 51% after one hour and in 72% after 2 hours. Headache recurrence was reported by 25% of the responders after a median time lapse of 14 hours. Adverse effects were reported by 22%, and were all short lasting and spontaneously reversible. Rapid efficacy, high and persistent response rate, improvement of headache, autonomic symptoms and general condition, and excellent tolerability are thus the reasons for the patients' preference of zolmitriptan over traditional abortive drugs.