Severe acute pancreatitis and pregnancy.

For most patients with pregnancy-associated pancreatitis there is little maternal survival threat and only occasionally are there foetal deaths. We describe 4 young women with pregnancy-associated severe acute pancreatitis who each had gallstones. Their ages were 17, 18, 20 and 24 years. Each was a tertiary referral to our unit in Glasgow and each pursued a life-threatening course with hospital stays ranging from 37 to 90 days. One patient required pancreatic necrosectomy for infected necrosis, another had percutaneous management of a pancreatic abscess and 2 had cystogastrostomy as treatment for pancreatic pseudocyst. All underwent early endoscopic sphincterotomy and later cholecystectomy. It is important to be aware that pregnancy-associated acute pancreatitis may be severe, posing a survival threat even in the youngest patients. Gallstones, as we reported almost 20 years ago, are the most common aetiological factor in such patients.

Oestrogen receptor status predicts local recurrence following breast conservation surgery for early breast cancer.

AIMS: To evaluate factors predicting locoregional recurrence in patients treated for early breast carcinoma by breast conservation surgery with or without radiotherapy. METHODS: A retrospective study of 256 patients was carried out, with special emphasis on the role of oestrogen receptor status. Other parameters studied included age, menopausal status, size of primary tumour, tumour type, axillary nodal status and adjuvant therapy. RESULTS: Multivariate analysis showed the following parameters to be independent predictors of locoregional recurrence. Radiotherapy (57% reduction in hazard, P = 0.004): expression of oestrogen receptors (52% reduction in hazard, P = 0.008); tamoxifen therapy (46% reduction in hazard, P = 0.023); tumour size (40% increase in hazard per cm, P<0.001). CONCLUSIONS: Within this study, lack of oestrogen receptor expression was a strong independent factor associated with a higher rate of locoregional recurrence. This may be of value in selecting a group of patients less suitable for breast conservation surgery.

Quantitative estimation of epidermal growth factor receptor and c-erbB-2 in human breast cancer.

Epidermal growth factor receptor (EGFR) expression by human breast cancer has been shown to predict poor patient outcome, as has amplification of the c-erbB-2 proto-oncogene. We have developed a quantitative immunohistochemical method for measuring protein levels of both receptors and have applied this to a series of 123 breast primaries. We find EGFR expression is substantially lower than normal in nearly all breast cancers (97%). Quantification of p185erbB-2 indicates overexpression in 91% of the tumors. Two separate tumor populations are apparent with levels of c-erbB-2 expression ranging from 0.33 to 19 and 45 to 480 times normal, respectively. Within the lower population, p185erbB-2 expression is inversely related to EGFR expression (rank correlation, P < 0.0005). Using fluorescent in situ hybridization we show that tumors in the latter population have c-erbB-2 amplification and that amplification is restricted to this group. Our findings indicate that significant overexpression of p185erbB-2 occurs in the absence of amplification; these lower levels of expression may have functional significance. Fifty-three patients underwent in vivo bromodeoxyuridine labeling, allowing flow cytometric analysis of tumor cell cycle kinetics. EGFR expression correlates directly to the labeling index (P = 0.011) and indirectly to potential doubling time (P = 0.010), but not to the duration of the S-phase (P = 0.502). Conversely, p185erbB-2 expression does not relate to indices of proliferation. Our results have important implications for the use of both receptor types as therapeutic targets.