Actual management of ductal carcinoma in situ of the breast.

Ductal carcinoma in situ (DCIS) represents a premalignant, non-invasive intraductal carcinoma of the breast. About 30% of all mammographically detected breast cancers contain DCIS. Due to the increased use of mammography during the last 20 years the incidence of DCIS has dramatically risen. Histologically it represents a heterogenous group of potentially malignant lesions. The prognosis of DCIS is excellent, but the optimal management of the disease still remains controversial. This review summarizes the results of the latest randomized trials and retrospective analyses investigating the optimal therapeutic strategies in the treatment of DCIS. In addition, it presents a range of treatment options on the basis of the guidelines of the German gynecological oncology group (AGO) 2008.

Biochemical tissue-specific injury markers of the heart and brain in postpartum cord blood.

OBJECTIVE: We sought to establish references ranges and to test the hypothesis that biochemical tissue-specific markers for the heart in umbilical cord blood of newborns with cardiac defects and intrauterine growth restriction (IUGR) are abnormal. STUDY DESIGN: A prospective study was conducted. Serum samples of the umbilical vein (n = 280) and artery (n = 156) from 599 healthy newborns at 37(+0)-42(+0) weeks of gestation were collected. Total creatine kinase (CK), CK-MB heart type (CK-MB), cardiac troponin T (cTnT), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and S100 were measured. Reference ranges for each marker were constructed. Concentrations of tissue-specific markers from umbilical cord blood of neonates with cardiac defects (n = 10) and IUGR (n = 41) were plotted against the established reference ranges. RESULTS: Reference ranges for each studied marker were established for both umbilical artery and vein. In fetuses with cardiac defects, both NT-proBNP (4/6 [66%] in the artery, 7/10 [70%] in the vein) and cTnT (2/10 [20%] in the vein) were increased. In fetuses with IUGR in the vein, NT-proBNP (10/41 [24%]) and cTnT (5/41 [12%]) were increased, whereas S100 (9/41 [21%]) was decreased. CONCLUSION: In a subset of neonates with cardiac defects or growth restriction, irrespective of the pH at birth, tissue-specific injury markers for the heart in umbilical cord blood are abnormal.

Long-term disease-free survival after hormonal therapy of a patient with recurrent low grade endometrial stromal sarcoma: a case report.

BACKGROUND: Approximately 50% of patients with low-grade endometrial stromal sarcoma (ESS) develop recurrent disease including mainly metastases of pelvis and lung. A solitary pulmonary metastasis of this disease is a rare phenomenon. CASE: After initial surgical treatment in 1990, a 28-year-old female developed solitary metastases of the lung in 1998 and 1999, which were surgically removed both times. The patient was then treated with goserelin for 2 years followed by anastrozole to date. She has since been disease-free. CONCLUSIONS: This case report emphasizes the importance of long-term follow-up and initial surgical treatment of low-grade ESS and suggests systemic hormonal therapy in case of recurrence.

Congenital diaphragmatic hernia, etiology and management, a 10-year analysis of a single center.

OBJECTIVE: To analyze congenital diaphragmatic hernia (CDH) during a 10-year period at the University of Kiel, from 1995 through 2004, in order to develop a strategy to improve prenatal diagnosis, to be able to consider endoscopical treatment for selected cases and to assess the current postnatal treatment strategies. METHODS: Data were obtained from the fetal medicine ultrasound department, from the birth registry, from the postmortem registry, from the neonatal intensive care unit, from pediatric surgery and from the genetic database. Data were subselected for chromosomes, genetic syndromes, for isolated CDH and for associated anomalies, the lung to head ratio and lung volumes were assessed. Data were analyzed respectively for gestation at diagnosis, the type of CDH, the perinatal management and the postnatal outcome. RESULTS: There were 29 cases of CDH, in 10/29 (34%) the parents requested termination of pregnancy of which two had already died during pregnancy, 12/19 (63%) survived, which was defined as discharge from the neonatal intensive care unit, seven newborns 7/19 (37%) died in the hospital, 5 of these 5/7 (71%) were delivered in Kiel. A prenatal diagnosis was performed in 16/29 (55%), 1/16 (6%), 7/16 (43%) and 8/16 (50%) in the 1st, 2nd and 3rd trimester, respectively; in 10/29 (34%) diagnosis was performed postpartum, in 3/29 (10%) the diagnosis was performed at autopsy following termination of pregnancy. When the liver was in the abdomen, 9/10 (90%) of the children survived, compared to only 3/8 (43%) when the liver was located in the thorax. A lung to head ratio of 0.81 at 24 weeks resulted in death due to pulmonary hypoplasia. CONCLUSIONS: The overall survival in CDH is around 50%, antenatal endoscopical therapy may only be considered, if the diagnosis is performed in the early second trimester, and selection criteria such as the lung to head ratio, associated defects and the chromosomal status can be applied.