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1.
Dermatology ; 223(2): 152-60, 2011.
Article in English | MEDLINE | ID: mdl-21997592

ABSTRACT

BACKGROUND: This study investigates the health-related quality of life in patients with vulvar lichen sclerosus (LS) and the patient-defined therapeutic benefit of clobetasol. METHODS: A survey analysis of 96 women with LS after treatment with clobetasol was performed. Quality of life was assessed with the Skindex-29. The Patient Benefit Index (PBI) was used to determine the therapeutic benefit. RESULTS: The overall response rate was 59.2%. Quality of life was most impaired by somatic symptoms (scale 'Symptoms' score 3.2) and emotional stress (scale 'Emotions' score 3.1), while social interactions (scale 'Functioning' score 1.9) played an inferior role (p < 0.001). Primary therapeutic goals 'to have confidence in the therapy' and 'to be free of itching' were achieved in 73.2 and 69.0% of patients who indicated the goal applied to them. The global PBI score was 3.06. In 93.2% of patients it was >1, indicating a potential benefit from clobetasol. CONCLUSION: Topical clobetasol is of potential therapeutic benefit for patients with vulvar LS and might therefore improve quality of life.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Clobetasol/therapeutic use , Quality of Life/psychology , Vulvar Lichen Sclerosus/drug therapy , Vulvar Lichen Sclerosus/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Analysis of Variance , Chronic Disease , Emotions , Female , Humans , Middle Aged , Patient Satisfaction , Social Participation/psychology , Surveys and Questionnaires , Vulvar Lichen Sclerosus/physiopathology , Young Adult
2.
Br J Cancer ; 103(7): 1048-56, 2010 Sep 28.
Article in English | MEDLINE | ID: mdl-20736952

ABSTRACT

BACKGROUND: To analyse the discriminative impact of osteopontin (OPN) and activated leukocyte cell adhesion molecule (ALCAM), combined with human epidermal growth factor 2 (HER2) and oestrogen receptor (ER) in breast cancer. METHODS: Osteopontin, ALCAM, HER2 and ER mRNA expression in breast cancer tissues of 481 patients were analysed (mRNA microarray analysis, kinetic RT-PCR). Hierarchical clustering was performed in training cohort A (N=100, adjuvant treatment) and validation cohorts B (N=200, no adjuvant treatment, low-risk) and C (N=181, adjuvant treatment, high-risk). RESULTS: Negative/low ER and HER2, high OPN and low ALCAM mRNA expression helped to identify patients at particularly high risk, showing shorter DFS, P<0.001, and OAS, P=0.001. Although both validation cohorts showed diverse risk and treatment profiles, this marker constellation was concordantly associated with shorter DFS and OAS (P<0.001 and P=0.075 for cohort B and P=0.043 and P<0.001 for cohort C, respectively). In multivariate analysis, this algorithm was the main independent prognostic factor. Cohort B: DFS, P=0.0065, OAS, not significant; cohort C: DFS, P=0.026, OAS, P<0.001. CONCLUSION: Activated leukocyte cell adhesion molecule and OPN mRNA expression has a strong discriminative impact on survival within cancer patients with low or negative expression of ER and HER2, so called 'high-risk' breast cancers, and might help in identifying patients who could benefit from new treatment approaches like targeted therapies in the adjuvant setting.


Subject(s)
Activated-Leukocyte Cell Adhesion Molecule/genetics , Breast Neoplasms/genetics , Osteopontin/genetics , Receptor, ErbB-2/genetics , Receptors, Estrogen/genetics , Adult , Aged , Breast Neoplasms/mortality , Cluster Analysis , Decision Trees , Disease-Free Survival , Eukaryotic Initiation Factor-3 , Female , Humans , Middle Aged , Oligonucleotide Array Sequence Analysis , Prognosis , RNA, Messenger/metabolism , Risk
3.
Dis Markers ; 28(2): 71-8, 2010.
Article in English | MEDLINE | ID: mdl-20364042

ABSTRACT

INTRODUCTION: Activated Leukocyte Cell Adhesion Molecule (ALCAM/CD166) gained increasing attention regarding tumorprogression and metastatic spread in breast cancer. The aim of this study was to examine ALCAM expression levels in primary breast cancer and distant metastases of the same patient within 29 autopsy cases to better understand the underlying mechanisms of metastases and the role of adhesion molecules in this process. MATERIAL AND METHODS: Paraffin-embedded tissue of the primary and distant metastases (N=84) were collected and ALCAM immunohistochemistry was performed. RESULTS: The primary tumor and all metastases showed a statistically normally distributed ALCAM expression. ALCAM expression level average differs between immunoreactive score (IRS) (mean) 4.16 (lung)-5.00 (adrenal gland). Of the metastatic ALCAM expression levels we obtained an intra-class correlation (ICC) of 80.9%, indicating a strong cluster effect of measurements in the same patient. ALCAM expression scores in metastatic sites and in the primary analyzed by hierarchical regression analysis showed that ALCAM expression in the primary is prognostic for ALCAM expression in all different sites of metastases (slope=0.773, p < 0.001, r(2)= 0.504). CONCLUSION: ALCAM expression in the primary is positively correlated to ALCAM expression in metastases within one single patient. This could show a tumorbiological context of ALCAM for the development of metastases in breast cancer.


Subject(s)
Antigens, CD/metabolism , Breast Neoplasms/metabolism , Carcinoma, Ductal, Breast/metabolism , Carcinoma, Ductal, Breast/secondary , Cell Adhesion Molecules, Neuronal/metabolism , Fetal Proteins/metabolism , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/metabolism , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Female , Humans , Immunohistochemistry , Middle Aged , Prognosis
4.
Pathologe ; 29 Suppl 2: 347-52, 2008 Nov.
Article in German | MEDLINE | ID: mdl-18810438

ABSTRACT

AIMS: Activated leukocyte cell adhesion molecule (ALCAM) is a cell surface immunoglobulin expressed in breast cancer (BC) and is assumed to be implicated in tumourigenesis and tumour progression. The importance of the adhesion molecule ALCAM for the response to taxane-free adjuvant chemotherapy was investigated. MATERIALS AND METHODS: Tissue specimens from 162 primary breast cancer patients were analyzed. Immunohistochemical staining (IHC) and Western blots (WB) were performed using monoclonal antibody against ALCAM. Relative protein amounts in WB bands were determined densitometrically. ALCAM mRNA expression was evaluated by microarray analysis (Affymetrix). RESULTS: In the normal breast ALCAM is expressed in luminal and basal epithelial cells. In BC samples, WB analysis showed a significant positive correlation of ALCAM levels with estrogen receptor status (p=0.04). For patients who received a taxane-free chemotherapy, a high ALCAM expression was predictive for a good response to chemotherapy. Median mRNA expression of ALCAM was 4.5-fold higher in patients alive at the time of follow-up compared to those who died of breast cancer. CONCLUSIONS: Higher ALCAM expression showed a positive correlation with estrogen receptor status and is a useful predictive marker for the response to taxane-free chemotherapy.


Subject(s)
Antigens, CD/genetics , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , Carcinoma, Ductal/drug therapy , Carcinoma, Ductal/genetics , Carcinoma, Lobular/drug therapy , Carcinoma, Lobular/genetics , Cell Adhesion Molecules, Neuronal/genetics , Fetal Proteins/genetics , Neoplasms, Hormone-Dependent/drug therapy , Neoplasms, Hormone-Dependent/genetics , Taxoids/administration & dosage , Blotting, Western , Breast/pathology , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Ductal/pathology , Carcinoma, Ductal/surgery , Carcinoma, Lobular/pathology , Carcinoma, Lobular/surgery , Chemotherapy, Adjuvant , Female , Gene Expression Regulation, Neoplastic/genetics , Humans , Kaplan-Meier Estimate , Neoplasm Staging , Neoplasms, Hormone-Dependent/pathology , Neoplasms, Hormone-Dependent/surgery , Oligonucleotide Array Sequence Analysis , Predictive Value of Tests , Prognosis , RNA, Messenger/genetics , Receptors, Estrogen/genetics
5.
Breast Cancer Res Treat ; 112(3): 419-27, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18172759

ABSTRACT

Activated Leukocyte Cell Adhesion Molecule (ALCAM, also called CD 166, MEMD) as cell surface immunoglobulin is reported as prognostic marker in breast cancer, but its predictive value has not yet been evaluated. We have analyzed ALCAM protein expression by Western Blot analysis (n = 160) and mRNA expression by cDNA microarray analysis (n = 162) in primary mammary carcinomas. Both expression results were obtained in 133 cases, showing a strong positive correlation between protein expression and mRNA expression (P < 0.001). Neither ALCAM protein nor mRNA expression are correlated to histological type, grading, stage or age of patient. However, ALCAM protein expression correlates positively with estrogen receptor status (ER) (P = 0.025). A stratified subgroup analysis showed positive correlation of high ALCAM mRNA expression with longer overall survival (OAS; P = 0.0012) in patients treated with adjuvant chemotherapy (n = 100). In contrast, patients with high ALCAM mRNA expression who did not receive chemotherapy tended to have a worse prognosis. Similar but weaker correlations were found regarding ALCAM protein expression data. The predictive impact of ALCAM mRNA expression in chemotherapy treated patients was corroborated by multivariate Cox regression analysis also including histopathological markers (P = 0.001 for OAS). Our overall results reveal that high ALCAM expression levels in primary tumors might be a suitable marker for prediction of the response to adjuvant chemotherapy in breast cancer.


Subject(s)
Antigens, CD/biosynthesis , Biomarkers, Tumor/metabolism , Breast Neoplasms/metabolism , Cell Adhesion Molecules, Neuronal/biosynthesis , Fetal Proteins/biosynthesis , Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnosis , Cell Line, Tumor , Chemotherapy, Adjuvant/methods , Disease-Free Survival , Humans , Middle Aged , Oligonucleotide Array Sequence Analysis , Prognosis , Proportional Hazards Models , RNA, Messenger/metabolism
6.
Int J Gynecol Cancer ; 17(5): 957-63, 2007.
Article in English | MEDLINE | ID: mdl-17359294

ABSTRACT

Uterine sarcomas are a rare form of uterine cancer. They occur in women from 40 to 60 years and are generally characterized by poor prognosis, a high rate of local recurrence, and distant metastases. Endometrial stromal sarcoma (ESS) accounts for 0.2% of all gynecological malignancies. Forms of possible treatment include surgery, radiotherapy, chemotherapy, and endocrine treatment. Randomized trials analyzing these treatment options are limited due to the rarity of this disease; therefore, a standard therapy could not be established thus far. To present an overview of the current treatment options of ESS, a search of Medline, Embase, and the Cochrane Library was performed and the results concluded. We report the case of a 32-year-old woman who presented with FIGO stage II ESS. Initial treatment with tamoxifen and local perfusion with cisplatin resulted in disease progression and were discontinued. A novel, therapeutic approach using two cycles of combination chemotherapy with doxorubicin and ifosfamide followed by surgery was applied. Five years after surgery, the patient is still in complete remission. Thus, we conclude that although there is no data from randomized trials available, chemotherapy in advanced or metastatic ESS can provide an opportunity for surgical treatment and can lead to long-term remission.


Subject(s)
Endometrial Neoplasms/therapy , Sarcoma, Endometrial Stromal/therapy , Adult , Female , Humans , Middle Aged , Treatment Outcome
9.
J Neurol Neurosurg Psychiatry ; 35(5): 664-8, 1972 Oct.
Article in English | MEDLINE | ID: mdl-4538888

ABSTRACT

In two cases of cerebrospinal fluid rhinorrhoea in which scinticisternography failed to identify the fistulae, the tracts were demonstrated by positive contrast ventriculography. It is postulated that the fistula communicated with the ventricles but was isolated from the subarachnoid space by adhesions (demonstrated at operation in one case). There was `high pressure rhinorrhoea' in one case. The rhinorrhoea ceased after insertion of ventriculoatrial shunt.


Subject(s)
Cerebrospinal Fluid Rhinorrhea/etiology , Fistula/diagnostic imaging , Adult , Cerebral Ventriculography , Cerebrospinal Fluid Rhinorrhea/therapy , Cerebrospinal Fluid Shunts , Contrast Media , Female , Fistula/complications , Humans , Male , Middle Aged , Pneumoencephalography , Serum Albumin, Radio-Iodinated
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