CIS case studies.

The onset of multiple sclerosis presents in 85% of cases as a subacute clinical event, the so-called clinically isolated syndrome. This event involves either focal or multifocal brain regions, most frequently the optic nerve, brainstem or spinal cord. The initial diagnosis of multiple sclerosis necessitates the demonstration of dissemination of pathology in time and space, as well as the exclusion of other alternative diagnoses, and can be challenging. Confirming a diagnosis of multiple sclerosis is a sensitive time for both patient and physician. The patient is faced with a difficult diagnosis and the physician must consider making difficult treatment decisions regarding therapy and follow-up care. This article presents a number of case studies that illustrate the diversity of presentation of clinically isolated syndrome and the challenges associated with confirming a diagnosis of multiple sclerosis.

Assessment of breast cancer vascularisation by Doppler ultrasound as a prognostic factor of survival.

Tumor growth and metastasis in breast cancer are correlated to neoangiogenesis, which became a potential candidate as a prognostic factor in this tumor type. Several studies have used immunohistochemical staining to count microvessel density as a marker of neoangiogenesis. This hospital-based retrospective pilot study measured vascularisation of early breast cancer by Doppler ultrasound and determined its value as a prognostic factor of overall survival in 147 women. The number of tumor related arteries were detected by color-coded Doppler ultrasound. We identified < or =10 tumor arteries and >10 tumor arteries in 117 and 30 women, respectively. Only weak correlation was found between the number of tumor arteries and established clinicopathological parameters such as tumor size (r=0.25) and lymph node involvement (r=0.13). In an univariate analysis, the strongest predictors of overall survival were number of tumor arteries [relative risk (RR) 4.60 (1.96-10.78)], positive axillary lymph nodes [RR 4.48 (1.59-12.60)] and angioinvasion [RR 4.26 (1.93-9.37)]. These three parameters were also found to be independent predictors of overall survival in a multivariate analysis [RR 3.21 (1.13-9.10) for positive lymph nodes; RR 2.69 (1.33-5.41) for number of tumor arteries; RR 2.84 (1.27-6.34) for angioinvasion]. Tumor vascularisation detected by Doppler ultrasound appears to be an independent predictor of overall survival in women with early breast cancer.