Ethnic disparities in breast cancer between Central Europe Caucasian women of Slavic origin and Middle East Turkish subjects.

The biological, cultural, behavioral and sociodemographic differences across populations modulate breast cancer profile among races or ethnics. Following this, we aimed to identify differences in breast cancer epidemiology, histopathology, and clinical presentation from representatives of central Europe (Slovakia) and Middle-East countries (Turkey) to point on ethnic disparities in cancer biology. The population based cross-sectional study analyzing 414 cases of primary breast carcinomas where 214 represented Caucasian and 200 Turkish subjects. The differences were found for age at the time of diagnosis (<0.0001), education, menopausal status (<0.001), tumor localization (<0.01), size (<0.0001), grade (<0.05) and axillary lymph node status (<0.001) between groups. Although carcinomas in Slovak subjects were of higher grade, negative axillary nodal status was more frequent finding compared to Turkish patients (50.0 vs. 41.0%). The Slovak group showed carcinomas to be more often ER positive (72.4 vs. 54.0%; <0.001), ER/PgR positive (54.6 vs. 49.0%; <0.001), of better Nottingham prognostic index (<0.001), and less frequent Her-2 positive (21.2 vs. 28.5%). Slovak population expressed significantly higher risk of non-sentinel lymph node metastases with increased tumor size, grade, vascular invasion and Her-2 positivity compared to Turkey population. The tumor size >2 cm and high tumor grade (G3) bears a risk of OR=7.62 and OR=3.10 in Slovak compared to OR=3.94 and OR=1.79 in Turkish cases, respectively.There are wide demographic and biological disparities in breast cancer between observed ethnics providing unique information for clinicians working at the level of screening or therapy in these populations.

Endoscopic sphincterotomy in the management of postoperative biliary fistula A complication of hepatic hydatid disease.

BACKGROUND: Intrabiliary rupture is the most common complication of hepatic hydatid disease (HHD), and persistent biliary leakage is the most frequent complication after surgery for HHD. In this study, we evaluated the outcome of endoscopic sphincterotomy (ES) performed in the management of postoperative biliary fistula in 33 patients with HHD and investigated the effects of the daily output of the fistula and the timing of the ES on the duration of the fistula. METHODS: Between January 1994 and April 2000, 33 patients (20 female, 13 male; median age, 44 years; range, 17-72) underwent ES at our clinics. The daily output of the biliary fistula ranged from 100 ml to 1000 ml (mean, 430 ml; in 18 patients < or = 400 ml; in 15 patients, >400 ml). The interval between the occurrence of the fistula and the performance of the ES ranged from 7 days to 5 months (median, 20 days; in 12 patients, < or = 2 weeks; in 21 patients >2 weeks). RESULTS: In patients with fistula output 400 ml (n = 18) and >400 ml (n = 15), the average closure times for the fistula after ES were 10.7 +/- 4.5 and 10.4 +/- 4.9 days, respectively (t-test: p = 0.847, t = 0.195). In patients (n = 2) with a short interval between the occurrence of the fistula and ES (<2 weeks), the average closure time for the fistula was 11.6 +/- 5.6 days, whereas for the patients (n = 15) with longer intervals (>2 weeks) it was 9.4 +/- 3.9 days (t = test: p = 0.254, t = 1.180). The drainage from the fistula stopped after an average of 9.88 +/- 4.83 days in all patients who underwent ES, and there were no any complications. Pearson's correlation test (PC) showed no significant relationship between the time for the complete closure time of the fistula after ES and the fistula output (PC=-0.253, p=0.155) or for the duration of the fistula before endoscopic retrograde cholangio pancreatography (ERCP) (PC = -0.333, p = 0.058). CONCLUSIONS: Endoscopic sphincterotomy is safe and effective and should be considered the minimally invasive procedure of choice for the management of postoperative biliary fistula due to HHD because it obviates the need for reoperation. If the sphincterotomy is successful, neither the daily output not the duration of the fistula has any influence on the time required for complete closure of the fistula.

Chemoprevention of DMBA-induced mammary gland carcinogenesis--preventive effects of free oxygen radical scavengers.

This study was carried out to determine the effects of Mangan-Desferrioxamine (Mn-DFX) and Verapamil (VRP) in 7,12-dimethyl-benz-[a]anthracene (DMBA) induced mammary carcinoma. 70 Spraque Dawley rats were divided into four groups; as DMBA alone, DMBA + Mn-DFX, DMBA + VRP, and control. Incidence, multiplicity, and size of tumors were evaluated in addition to analyses of DNA ploidy status and proliferation index by flow cytometric technique. The results revealed that Mn-DFX and VRP caused significant decreases in tumor incidence (p < 0.02 and p < 0.05), multiplicity (p < 0.02 and p < 0.05), size (p < 0.05 and p < 0.02), and proliferation index (p < 0.05 and p < 0.02) without any toxic effect. The appearance of first tumors in Mn-DFX and VRP groups was also later than in the DMBA alone group (10th and 11th week versus 6th week). In conclusion, Mn-DFX and VRP have offered prevention in experimental mammary carcinogenesis. These agents caused slower tumor growth, though they could not achieve a complete prevention.

Catheter complications associated with intraperitoneal chemotherapy.

Catheter complications associated with intraperitoneal chemotherapy were evaluated in 171 patients (pts) with primary intra-abdominal malignancies. In 96 pts and 488 courses, single-use catheters (SUC) (3/G 14 Braun) were used between years 1990-1993. In 75 pts and 283 courses a semi-permanent subcutaneous implantable port and catheter system (SIPC) (T 2035/460 mm-F 14-76 Braun) was used between years 1993-1996. Cisplatin (60-75 mg/sqm), 5-fluorouracil (600 mg/sqm), calcium folinate (150 mg), etoposide (180 mg/sqm), mitoxantrone (12-15 mg/sqm) were given in various combinations and periods to patients with ovarian carcinoma (106 pts), gastrointestinal carcinoma (43 pts), hepatocellular carcinoma (17 pts) and mesothelioma (5 pts). The incidence of patients with complications was significantly higher in SUC (45%) than SIPC (23%) (p=0.001). Colon puncture (8.8%, p<0.0001) and subcutaneous leakage (3.7%, p<0.01) rate of the courses were significantly higher in SUC. Pain related to catheter complications (6%, p<0,0002), local infection (1.4%, p=0.02) and obstruction (1.4%, p=0.02) were significantly higher in SIPC. The most important local complications were intra-abdominal fibrosis and adhesions that were surgically documented in 90% of the ovarian cancer patients, and were more severe in patients with the SIPC system. The complication rate and the complication type of these two catheters were found to be significantly different in this retrospective analysis; in order to determine the real complication rate, safety, efficacy and overall acceptability of the catheters, a randomised trial is needed.

The effects of sterile or infected bile and dropped gallstones in abdominal adhesions and abscess formation.

BACKGROUND: The effects of gallstones and sterile or infected bile on postoperative adhesions and abscess formation were investigated in Sprague Dawley rats. METHODS: The first three groups were injected intraperitoneally with serum saline, sterile bile, or infected bile, respectively. Laparotomy was adjusted to the next seven groups. Serum saline, sterile bile, and infected bile were injected in the fourth through sixth groups intraperitoneally, respectively. Gallstones were placed intraabdominally to the seventh through ninth groups. The injections of sterile bile in group 7 and of infected bile in group 8 were added to laparotomies. Only laparotomy was carried out in group 10. RESULTS: Abscess formations were seen only in infected-bile-injected groups. Significant adhesion formations were seen in infected-bile groups. Sterile bile and/or gallstones had no significant effect in abscess or adhesion formation. CONCLUSIONS: Results suggest that noninfected gallstones and sterile bile, even in combination, do not increase postoperative intraabdominal complications in rats.

Protective effect of desferrioxamin against TPA caused inflammation in CD-1 mouse skin.

This study was planned to investigate the possible inhibitory effect of the oxygen radical scavenger agent desferrioxamin on 12-0-tetradecanoylphorbol-13-acetate (TPA) induced oedema and hyperplasia in the skin of 119 CD-1 mice. Topical application of different doses of desferrioxamin (20 ng, 200 ng, 2 microg, 20 microg and 200 microg per mouse) 10 min prior to 1 nmol TPA, inhibited oedema of mouse ears significantly (P < 0.02-0.001) except with the doses of 200 ng and 20 ng/mouse. The inhibitory effect of desferrioxamin (2 mg/mouse) in TPA induced mouse skin hyperplasia was also investigated in four groups of 20 CD-1 mice. Desferrioxamin produced an 83.7% reduction in epidermal thickness (P<0.0001) and an 85.8% reduction in the number of vertical cell layers (P <0.0001). Data also indicated the inhibitory effect of desferrioxamin against TPA caused infiltration of neutrophiles (P <0.02). These results suggest that the free oxygen radical scavenger agent desferrioxamin has a chemopreventive effect against TPA induced inflammation and hyperplasia.

The effect of bile on the gastric mucosal barrier in the presence and after blockade of normal gastric acidity.

Induced physiologic changes in the gastric mucosa was investigated both in the presence of normal gastric acidity and after parietal cell vagotomy (PCV), in dogs. Cholecystogastrostomy and common bile duct ligation was performed in eleven and PCV was added to this procedure in five dogs. During histopathological examination, 70 days after the procedure, both groups proved to have superficial gastritis. The most prominent changes occurred at the anastomotic site and at the gastric antrum. Bile had broken down the gastric mucosal barrier and the Na+ flux roughly paralleled the H+ back diffusion. Potassium had taken part in the bi-directional movement of ions in the gastric mucosa, as well as the sodium flux, and in the late phase it accompanied the action of sodium ions. The destruction of the K+-H+ pump, possibly located in the plasma membrane, may be the responsible mechanism of this flux.

Effect of bile infusion on the dog kidney.

Infusion of small amounts of bile in a series of dogs produced natriuresis and diuresis apparently due to decrease in proximal tubular resorption of sodium and water. Such losses of sodium and water, if continued, would produce some degree of hypovolemia, and extracellular-fluid deficit. Chronic studies are now in progress to clarify this point. The finding of unsuspected hypovolemia in jaundiced patients suggests that this mechanism may be operative in the human kidney exposed to elevated bilirubin levels. The importance of replacement of blood and extracellular-fluid volume before and during surgery in jaundiced patients is stressed.