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The expression of the classic steroid receptors ERalpha and PR-A has been correlated with stage, histological grade and survival in endometrial cancer. Endometrial cancer samples (293) were immunohistochemically analysed with monoclonal antibodies against the four steroid receptors. The loss of ERalpha, PR-A and PR-B resulted in a poorer survival in endometrial cancer patients, while ERbeta expression did not demonstrate any correlations with several analysed clinicopathological characteristics and did not affect survival. Additionally, multivariate survival analysis demonstrated that PR-B was a significant independent prognostic factor for cause-specific survival. In contrast, although ERalpha and PR-A showed a significant association between different endometrial histological subtypes and grading, both receptors were not independent factors with survival in endometrial carcinoma patients. Therefore, the PR-B immunostaining might be used as an easy, simple and highly efficient marker to identify high-risk patients and may aid in the selection of patients for a more aggressive adjuvant therapy. [ABSTRACT FROM AUTHOR]

Background: The types of treatment for borderline personality disorder devised over the last few decades are often difficult to implement in therapy centres. stepps is a group treatment for this disorder which is easy to implement., Aim: To compare the efficacy of stepps supported by limited individual treatment with 'treatment as usual' (tau)., Method: 79 patients with bpd were randomly assigned to stepps or to tau. Measurements were taken before and after the intervention and at one-year follow-up. Outcome measures were: borderline and general psychiatric symptomatology, suicide attempts, quality of life and use of care services. results stepps led to a larger reduction in symptoms than did tau, the difference being still significant at follow-up. 70% of patients treated with stepps showed improvement compared to 47% of patients treated with tau. In both treatment groups the percentage of patients who recovered was small. There was no difference in the number of suicide attempts in each group. stepps led to a greater improvement in quality of life than did tau, particularly at follow-up. Care service use seemed about equal., Conclusion: The efficacy of treatment for bpd can be improved by the introduction of stepps, which is relatively simple to implement.

Purpose: There is an urgent need for markers that can predict the efficacy of adjuvant chemotherapy in patients with solid tumors. This study was designed to evaluate whether monitoring of micrometastases in bone marrow can predict the response to systemic chemotherapy in breast cancer., Patients and Methods: Bone marrow aspirates of 59 newly diagnosed breast cancer patients with either inflammatory (n = 23) or advanced (> four nodes involved) disease (n = 36) were examined immunocytochemically with the monoclonal anticytokeratin (CK) antibody A45-B/B3 (murine immunoglobulin G(1); Micromet, Munich, Germany) before and after chemotherapy with taxanes and anthracyclines., Results: Of 59 patients, 29 (49.2%) and 26 (44.1%) presented with CK-positive tumor cells in bone marrow before and after chemotherapy, respectively. After chemotherapy, less than half of the previously CK-positive patients (14 of 29 patients; 48.3%) had a CK-negative bone marrow finding, and 11 (36. 7%) of 30 previously CK-negative patients were CK-positive. At a median follow-up of 19 months (range, 6 to 39 months), Kaplan-Meier analysis of 55 assessable patients revealed a significantly reduced overall survival (P =.011; log-rank test) if CK-positive cells were detected after chemotherapy. In multivariate analysis, the presence of CK-positive tumor cells in bone marrow after chemotherapy was an independent predictor for reduced overall survival (relative risk = 5.0; P =.016)., Conclusion: The cytotoxic agents currently used for chemotherapy in high-risk breast cancer patients do not completely eliminate CK-positive tumor cells in bone marrow. The presence of these tumor cells after chemotherapy is associated with poor prognosis. Thus, bone marrow monitoring might help predict the response to systemic chemotherapy.

Despite current advances in antibody-based immunotherapy of breast and colorectal cancer, we have recently shown that the actual target cells (e.g., tumor cells disseminated to bone marrow) may express a heterogeneous pattern of the potential target antigens. Tumor antigen heterogeneity may therefore represent an important limitation of the efficacy of monospecific antibody therapy. To measure the efficacy of such a monospecific approach, we analyzed the elimination of tumor cells coexpressing the epithelial cell adhesion molecule (EpCAM) under therapy with murine monoclonal antibody 17-1A (Edrecolomab) directed against EpCAM. In bone marrow aspirates from 10 breast cancer patients with metastatic (n = 8) and locoregional recurrence (n = 2), tumor cells were identified with the antibody A45-B/B3 directed against the epithelial differentiation marker cytokeratin (CK) and simultaneously typed for EpCAM expression using the antibody 17-1A. Patients were treated with a single dose of 500 mg of Edrecolomab and monitored by bone marrow analyses before and at days 5-7 after antibody treatment. In all 10 patients, we assessed a marked reduction in the mean numbers of both CK+ cells (73 versus 15; P = 0.003, t test) and EpCAM+/CK+ cells (17 versus 1; P = 0.003, t test) per 10(6) bone marrow cells. Complete elimination of EpCAM+ cells was possible in four patients. We conclude that Edrecolomab can be used in breast cancer patients to target isolated EpCAM+/CK+ cancer cells. Using CK-based immunoassays, we reliably detected residual tumor cells in bone marrow and typed EpCAM expression. This allowed us to monitor the cytotoxic elimination of such cells after Edrecolomab application. Selection of EpCAM-/ CK+ tumor clones showed that further antibodies directed against tumor-associated antigens are warranted to improve the efficacy of monospecific approaches.

From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8%) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60% of the recurrences occurred within 2 years after the primary treatment. In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.

104 patients submitted to primary irradiation for cervix carcinoma were examined by means of urodynamic methods of diagnosis in order to investigate the functional changes of the lower urinary tract induced by therapy. 34 patients could be examined prior to therapy, 19 and 12 patients, respectively, were examined six and 18 months on an average after the treatment. Another group of 70 patients had retrospective check-up examinations with average intervals of five and ten years. Hydronephrosis occurred only as a late result after more than six years in 12% of the irradiated women. The incidence of residual urine, significant bacteriuria, and disturbed sensory function of the bladder was not important. All patients were incontinent two years after the irradiation; 60% of the cases of incontinence were due to the bladder and 40% to the urethra. The increase of urgency incontinence is possibly caused by a radiofibrotic reaction of the bladder, as is shown by correspondent cystometric alterations: the bladder tonicity increased, whereas the bladder capacity decreased. These alterations were only partially reversible. The stress incontinence, however, was found already before the treatment. The maximum urethral closing pressure, which often indicates incontinence due to the urethra, was not modified by the irradiation. An increased stress incontinence, probably caused by advanced age, was found only after six years or later. The problems resulting from functional changes should be taken into consideration in the course of post-therapeutic care, i.e. the patients concerned should be given instructions for a regular bladder training.

Microcalcifications on the mammogram could be an important indication for an occult carcinoma. Up until 31 December 1976, we intentionally removed such grouped microcalcifications 218 times in a group of 17,523 examined females (32,245 mammographs). The selection was confirmed radiologically. The acquired material was then examined histologically via an complicated technique. We found 35 carcinomas and 89 proliferating mastopathies of which 34 required at least strict supervision and sometimes additional treatment. - With strict indications, one-third of the previously clarified cases revealed disorders requiring treatment. In over one-half of the cases, the films indicated nothing of a serious nature. It must, however, be noted that an existing cancer is not always discovered in spite of the intentional excision of microcalcifications. This only serves as an indirect indication.

In our first paper we dealt with the reproduction of low contrast ranges during the radiological examination of the breast. In the present paper we are concerned with medium contrast ranges, using a semi-objective procedure. This again depended on visual evaluation of test films of grids with variable grid ratios. For mammography rotating molybdenum and tungsten tubes with various filters were available. The advantages of xere radiography in rendering detail were less marked in these medium contrast ranges. The disadvantage of scatter is again less marked, but the resolution of non screen film for small and medium-sized objects is considerably greater. However, xero-radiography, using a tungsten tube with 0.5 mm. Al. filtration represents a satisfactory compromise between image quality and radiation dose for the demonstration of small and medium contrast ranges.

In order to compare the performance of various mammographic techniques, xeroradiograms were obtained of sixteen freshly amputated breasts using tungsten and molybdenum rotating anodes. A film without screens (Kodak Definix Medical) and a film-screen system (screens: MR50, film Mammoray RP 3 PE FW) were employed. Exposures during xeroradiography were varied in that, when using the tungsten tube, a 2.5 mm. aluminium filter was added to the 0.5 mm. aluminium filtration inherent in the tube; when using the molybdenum tube, there was a choice between 0.03 mm. Mo. and 0.5 mm. aluminium filtration. The xeroradiograms obtained with the molydenum tube and molybdenum filter were of good quality, as were those obtained with this type of tube and nonscreen film. In view of the carcinogenetic risk of mammography, it is open to discussion whether one should aim at optimal film quality, since improved quality is associated with a higher radiation dose to the breast, or whether one should be satisfied with "adequate" quality. In our series the quality produced by the film-screen combination was, in general, acceptable. Compared with all other procedures, this system produces the lowest radiation dose of any mammographic technique. For this reason further improvements in technique, such as automatic exosure devices, film-screen packs suitable for routine use and improved quality of image are of practical interest.

In the last 19 years 47,518 women had mammographies at the Department of Gynaecology of the University of Erlangen. 1653 patients had 2215 galactograms. Biopsies of the breast indicated by mammography were done in 1521 cases. 955 cases showed micro-calcifications in groups. 566 showed abnormal galactograms. The microscopic examination in the 955 cases with microcalcifications showed invasive carcinoma, carcinoma in situ or atypical epithelial proliferations in 1/3 of the cases In 10% of the cases small calcified fibroadenomata, papillomas or granulomas were found. In 60% of the biopsies mammary dysplasia partly with nonatypical epithelial proliferations were found. When the galactogram showed pathological contours the breast tissue was excised in a segment. In over 40% of 566 segmental excisions papillomata were the cause of pathological secretions from the breast. Ductal carcinomas, carcinoma in situ and extensive intraductal solid papillary or adenomatous epithelial proliferations were found in 27% of the cases. Approximately the same number of cases did not show atypical epithelial proliferations. Delay in the early diagnosis of changes which may be the first sign of malignant breast disease can be avoided by good cooperations between the physicians treating the cases.