Circadian rhythms of basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), cortisol, and melatonin in women with breast cancer.

BACKGROUND: Circadian rhythms in plasma concentrations of many hormones and cytokines determine their effects on target cells. METHODS: Circadian variations were studied in cortisol, melatonin, cytokines (basic fibroblast growth factor IbFGF], EGF, insulin-like growth factor-1 [IGF-1]), and a cytokine receptor (insulin-like growth factor binding protein-3 [IGFBP-3]) in the plasma of 28 patients with metastatic breast cancer. All patients followed a diurnal activity pattern. Blood was drawn at 3h intervals during waking hours and once during the night, at 03:00. The plasma levels obtained by enzyme-linked immunoassay (ELISA) or radioimmunoassay (RIA) were evaluated by population mean cosinor (using local midnight as the phase reference) and by one-way analysis of variance (ANOVA). RESULTS: Cortisol and melatonin showed a high-amplitude circadian rhythm and a superimposed 12h frequency. bFGF showed a circadian rhythm with an acrophase around 13:00 with a peak-to-trough interval (double amplitude) of 18.2% and a superimposed 12h frequency. EGF showed a circadian rhythm with an acrophase around 14:20, a peak-to-trough interval of 25.8%, and a superimposed 12h frequency. IGF-1 showed a high value in the morning, which is statistically different (t test) from the low value at 10:00, but a regular circadian or ultradian rhythm was not recognizable as a group phenomenon. IGFBP-3 showed a low-amplitude (peak-to-trough difference 8.4%) circadian rhythm with the acrophase around 11:00 and low values during the night. CONCLUSIONS: (1) Circadian periodicity is maintained in hospitalized patients with metastatic breast cancer. (2) Ultradian (12h) variations were superimposed on the circadian rhythms of the hormones and several of the cytokines measured. (3) Studies of hormones and cytokines in cancer patients have to take their biologic rhythms into consideration. (4) The circadian periodicity of tumor growth stimulating or restraining factors raises questions about circadian and/or ultradian variations in the pathophysiology of breast cancer.

[Biliary decompression by tumor drilling and endoprosthesis with a hepatocholedochal tube in a case of cholangiocarcinoma]. / Decompresiune biliara prin foraj tumoral si endoprotezare cu tub pierdut hepatocoledocian într-un caz de colangiocarcinom.

The paper reports on the case of an 82-year-old patient, operated for a cholangiocarcinoma with high location, involving the bifurcation of the hepatic ducts. The surgery consisted of an endo-lumen tumoral drilling, followed by assembling two tubes introduced in the hepato-choledochal canal for ensuring the internal biliary drainage. A survival of more than 30 months was obtained. The authors show the possibility of using this palliative method, followed by a good result when a radical surgery cannot be used.

[Congenital cystic dilatation of the common bile ducts]. / Dilatatia chistica congenitala a caii biliare principale.

The paper reports on a case of congenital cystic dilatation of the main bile duct in a female patient, 3 years old, with a clinical evolution of the disease from 2 years old. The anamnestic data corroborated with iv cholangiography and hepatobile echography specifies the clinical diagnosis that was intraoperatively confirmed. The case was solved by resection of the cystic bag, followed by hepatojejunostomy on the loop ablated "en Y" à la Roux.

[The value and limits of endorectal sonography in the preoperative stage classification of rectal cancer]. / Wert und Grenzen der endorektalen Sonographie in der präoperativen Stadieneinteilung des Rektumkarzinoms.

The article deals with the valuation of endorectal and abdominal sonography in preoperative staging of rectal carcinoma. Data processing of 40 patients suffering from tumours of the rectum examined rectoscopically, by biopsy and via sonography showed that endorectal sonography can achieve preoperative staging (T) with a sensitivity of 89%, a specificity of 100%, a positive predictive value of 89% and a negative predictive value of 100%, the overall accuracy being 81%. Identification of pararectal adenopathies can be performed with a sensitivity of 16% and a specificity of 100%. Liver metastases were determined with a sensitivity and specificity of 100%. Hence, endorectal sonography is a valuable method for preoperative staging of carcinoma of the rectum.