Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers.

OBJECTIVES: Most research addressing needs and concerns of young patients with breast cancer (≤40 years) is retrospective. The HOHO European protocol is a prospective multicenter cohort study of young women with newly diagnosed breast cancer, about fertility, psychosocial and quality of life concerns. Here we report the baseline data and focus on predictors of fertility concerns. MATERIALS AND METHODS: Patient surveys and medical record review were used. The baseline survey included sociodemographic, medical and treatment data as well as questions on fertility concerns and preservation strategies. Subscales from the CAncer Rehabilitation Evaluation System-Short Form (CARES-SF) were administered to measure specific quality of life aspects. Uni- and multivariable modeling were used to investigate predictors of greater fertility concern. RESULTS: Among 297 eligible respondents, 67% discussed fertility issues before starting therapy, 64% were concerned about becoming infertile after treatment, and 15% decided not to follow prescribed therapies. Fifty-four percent of women wished future children before diagnosis; of these, 71% still desired biologic children afterwards. In multivariable analysis, not having children was the only patient characteristic significantly associated with fertility concerns at diagnosis. Twenty-seven percent used fertility preservation strategies. Women who received chemotherapy reported greater physical (p = 0.021) and sexual difficulties (p = 0.039) than women who did not. Women who were married or had a partner reported less psychosocial problems than single women (p = 0.039). CONCLUSIONS: Young women with newly diagnosed breast cancer have several concerns, including, but not limited to, fertility. The HOHO European study provides valuable information to develop targeted interventions.

Partial irradiation of the breast: Old challenges, new solutions.

Breast-conserving treatment, characteristically consisting of surgical removal of the tumor and post-operative whole breast irradiation, is nowadays considered as the standard therapeutic approach for most women with stage I/II, invasive breast cancer. Recently, a number of institutions started investigating the feasibility and safety of novel approaches in radiotherapy, modulating concomitantly treatment time and irradiation volume. Whilst this strategy is still under investigation, recent clinical studies on accelerated partial breast irradiation with intra-operative radiotherapy or high conformality irradiation strongly suggest that the way patients with early breast cancer are irradiated should be revisited.

[Immobilization devices in conformal radiotherapy for non-small cell lung cancer]. / Systèmes d'immobilisation pour la radiothérapie conformationnelle du cancer bronchique non à petites cellules.

When considering three-dimensional conformal radiotherapy for non-small cell lung cancer, the uncertainties about treatment can be quite significant, due to set-up errors and organ or tumor motion. These can be important causes of treatment failure. Immobilization devices have only been studied recently in a scientific manner in the domain of chest tumors, presumably because other factors such as tumor motion were felt to be more important causes of treatment uncertainties. An international survey on immobilization devices in the treatment of non-small cell lung cancer has shown that about half of the centers are using three-dimensional conformal radiotherapy, and among these, only two-thirds use immobilization devices on a routine basis. Very few use internal fiducials. Current data on set-up errors show that the average discrepancy is about 5 mm, but in some cases it can be more than 15 mm. A recent study has demonstrated that less positioning corrections during treatments were needed for the patients who were immobilized. Another work indicates that there were no differences between a T-bar immobilization device and a system using chemical foams. Other works indicate that internal motion of bronchial tumors can vary greatly, depending on their location. A number of clinical groups are looking at minimizing the consequences of internal motion, but the currently proposed techniques appear to be cumbersome. New studies will be necessary in order to improve the knowledge of daily positioning and the effect of internal motion. Until then, it is essential to take care when considering narrow margins in conformal radiotherapy of non-small cell lung cancer.

Esophageal cytology in the follow-up of patients with treated upper aerodigestive tract malignancies.

BACKGROUND: Patients with an history of carcinoma of the upper aerodigestive tract are at high risk for recurrence or the development of new tumors in this region. In the majority of follow-up protocols, these patients undergo radiologic and endoscopic evaluation as a means of surveillance for the early detection of recurrence. The brush biopsy-capsule technique represents a noninvasive and inexpensive screening device for this patient population. In the current study, the authors retrospectively assessed the sensitivity, specificity, and predictive value of esophageal brush-capsule cytology for the detection of malignant lesions of the upper aerodigestive tract in this high risk patient population. METHODS: Cytologic specimens from 334 patients with previously treated upper aerodigestive malignancies were available for review. The cytologic, endoscopic, and clinical follow-up of each case were studied over a follow-up period of 3 years. Gold standard was the clinical follow-up for the negative cases (who were not submitted to biopsy) and biopsy for the positive cases. Sensitivity, specificity, and predictive value were calculated. RESULTS: Using cytology 33 malignancies were detected in 25 patients during a 3-year follow-up period. The test was found to have a sensitivity of 88.7% and a specificity of 90.7%. In 66% of cases the malignancies were located in the oropharynx; the others were located in the esophagus. In 70% of cases the malignancies were detected at an early stage. CONCLUSIONS: Esophageal brush-capsule cytology is a simple noninvasive technique that has been proven to be useful in the early detection of metachronous and recurrent neoplasms in the follow-up of patients with previously treated carcinomas of the ear, nose, and throat.

Abrasive esophageal cytology for the oncological follow-up of patients with head and neck cancer.

OBJECTIVES: The occurrence of a second primary cancer in the esophagus in patients with head and neck squamous cell carcinoma is frequent and is associated with a poor prognosis. The aim of this study was to evaluate the yield of abrasive esophageal cytology as a means of screening for metachronous cancer of the upper aerodigestive tract. STUDY DESIGN: We retrospectively reviewed the results of abrasive esophageal cytology performed twice yearly for the screening of patients with prior head and neck cancer. METHODS: From 1987 to 1996, 320 patients treated for head and neck cancer underwent 1,673 abrasive cytology examinations of the esophagus during a mean follow-up period of 4 years. Cytological results were classified as negative, suspect, or positive for malignancy. RESULTS: Twenty-five patients without symptoms had one or more suspect or positive cytologic findings, leading to 29 endoscopic examinations. These revealed 20 premalignant or early malignant lesions of the esophagus (2 dysplasias, 18 squamous cell carcinomas), 2 glandular carcinomas, and 10 clinically unsuspected oral or pharyngeal carcinomas. In seven patients, positive cytological results were associated with clinically visible head and neck cancer. Of the 34 patients with suspect cytological results for malignancy, 10 had no evidence of tumor at endoscopy and 24 had no endoscopic examination because of refusal or because suspected cells were not found in additional examinations. Negative results on cytological examination were found for 254 patients throughout their follow-up, and none of them developed esophageal cancer during a mean follow-up period of 3 years. CONCLUSIONS: For patients with head and neck cancer, abrasive sponge cytology is useful for detecting esophageal cancer at an early stage. In addition, it may reveal unsuspected second primaries or recurrences in the head and neck region.

The anterior mandibular positioning device for the treatment of obstructive sleep apnoea syndrome: experience with the Serenox.

Anterior mandibular positioning devices are seldom used at present in the treatment of obstructive sleep apnoea syndrome (OSAS). The aim of our study was to evaluate the efficiency, the side-effects and the patient compliance with one type of device made in Switzerland, the Serenox. This device is designed to keep the mouth closed with the mandible forward, avoiding the vibration of the soft palate. Between January 1996 and October 1997, 15 patients with OSAS were treated using a Serenox. One of them stopped using the device after 6 weeks due to the persistence of temporomandibular joint pain. Serenox was successful in 13 of the remaining 14 patients. The median pretreatment apnoea/hypopnoea index (AHI) of 36.25/h was decreased to 5.5/h after treatment (P < 0.002). Snoring and daytime sleepiness were notably reduced. The side-effects were frequent but mild and disappeared after a few weeks of adaptation. In conclusion, 87% (13/15) of the patients were treated successfully. Indications for the use of a mandibular positioning device include snoring, upper airway resistance syndrome and light to mild OSAS without severe obesity.

Prolonged cardiopulmonary resuscitation during acute disopyramide poisoning.

A case is reported of sustained electromechanical dissociation due to deliberate disopyramide over-dosage in a young healthy girl. Circulatory recovery was achieved with standard resuscitative measures, including prolonged cardiac massage and isoproterenol infusion plus high dose calcium chloride. Neurological recovery was complete.

Sodium-independent effect of aldosterone on initial rate of ouabain binding in A6 cells.

To estimate the early effect of aldosterone on the number of active Na(+)-K+ pumps at the basolateral membrane of amphibian tight epithelia, we have measured the initial rate (at 4 min) of [3H]ouabain binding to the basolateral membrane of intact monolayers of A6 cells grown on permeable supports. Within 3 h, aldosterone induced a threefold increase of the Na transport and, simultaneously, a twofold increase of the binding rate of ouabain. Because the affinity of ouabain, estimated either by equilibrium binding studies or inhibition kinetics, was not modified by aldosterone, the effect on the initial rate of ouabain binding was due to an increase in the number of binding sites. This effect on ouabain binding was not prevented by 10 microM amiloride, which reduced the transepithelial sodium transport below control level. By contrast, the effect of aldosterone on ouabain binding was abolished by cycloheximide (5 micrograms/ml) or actinomycin D (2 micrograms/ml), doses which inhibited the aldosterone-dependent sodium transport response. These data suggest that aldosterone elicits an early, sodium-independent, protein synthesis-dependent increase in the expression of active Na(+)-K(+)-ATPase molecules.

[An isometric exercise for the diagnosis of chronic obliterating arteriopathies of the lower extremities]. / Uno sforzo isometrico per la diagnosi delle arteriopatie obliteranti chroniche degli arti inferiori.

A non invasive method for the diagnosis of occlusive diseases of the peripheral arteries and the follow-up of therapy is proposed. The method consists in the performance of an isometric effort of the inferior limbs and the Doppler detection of the dorsalis pedis systolic pressure. 41 patients with different degrees of peripheral artery involvement have been studied and the results compared with those obtained in a control group of 12 normal subjects, equally matched for ages and sex. In the normal subjects the maximal dorsiflection of the feet for 30 seconds caused a mean increase of the heart rate of 20% and no changes of the systolic blood pressure. In the patients with peripheral artery disease the isometric effort caused, contemporary to the increase of the heart rate, a decrease of the dorsalis pedis systolic pressure, that varied from 15 to 100% according to the degree of the arterial involvement. A close correlation was found between the degree of the percent reduction of peripheral systolic pressure and the entity of the arterial involvement, as evidenced by other invasive and non-invasive methods. The method proposed appears useful for a proper diagnosis of peripheral vascular diseases in those patients who cannot undergo invasive investigations or the treadmill effort test.