Management of skin-sparing mastectomy: Results of a survey of German Hospitals

Background: The aim of this study was to evaluate the current management of skin-sparing mastectomy in German hospitals and to determine its oncologic safety. For this purpose, 100 surgeons were surveyed regarding their use of skin-sparing mastectomy. Results: Almost all surveyed hospitals performed skin-sparing mastectomy. Most of them believe that the recurrence rate is equal to that of conventional mastectomy. 95% regard inflammatory cancer as a contraindication to skin-sparing surgery. Most of the hospitals thin out the skin without leaving any macroscopic glandular tissue behind, and 73% leave the nipple-areola complex (NAC) on the basis of frozen sections. Volume replacement is most commonly done with latissimus dorsi muscle flaps and pedicled TRAM flaps. In 76% of the surveyed hospitals, reconstruction after mastectomy is performed by the gynecological department. Conclusion: Skin-sparing mastectomy is considered to be the best cosmetic option for breast reconstruction in selected breast cancer patients. At present, statistical proof of its oncologic safety is lacking. The surgical techniques used for skin-sparing mastectomy have not yet been standardized. In order to achieve standardization, careful discussion-making and evaluation remain important

Pregnancy-associated breast cancer - Special features in diagnosis and treatment

For obvious psychological reasons it is difficult to associate pregnancy - a life-giving period of our existence with life-threatening malignancies. Symptoms pointing to malignancy are often ignored by both patients and physicians, and this, together with the greater difficulty of diagnostic imaging, probably results in the proven delay in the detection of breast cancers during pregnancy. The diagnosis and treatment of breast cancer are becoming more and more important, as the fulfillment of the desire to have children is increasingly postponed until a later age associated with a higher risk of carcinoma, and improved cure rates of solid tumors no longer exclude subsequent pregnancies. The following article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular consideration of cytostatic therapy

Behaviour of suspended particulate matter (SPM) and selected trace metals during the 2002 summer flood in the River Elbe (Germany) at Magdeburg monitoring station

International audienceIn August 2002, in the worst flooding in more than 100 years, the River Elbe destroyed built-up areas and caused widespread erosion and the relocation of soils and river sediments. To assess the pollutants entering the water, surveys of dissolved constituents and suspended particulate matter (SPM) were carried out daily during the flood at a monitoring station near Magdeburg. The sampling point is part of the network of the International Commission for the Protection of the Elbe (ICPE). The results were compared with those of previous flood studies which used the same sampling strategy. Unlike past floods, the 2002 flood was characterised by the transport of relatively fine suspended material with a low mass concentration. Owing to different input sources, the maxima of dry weight and of particle number concentration occurred at different times. Hg, Fe, Mn, Zn, Cu, Ni and Cr showed a maximum concentration concurrent with the dry weight of the SPM, whereas the maximum concentrations of As, Pb, and Cd coincided with the particle number concentration peak. The concentration of particulate matter decreased rapidly, unlike the concentrations of dissolved substances such as DOC and trace metals, as well as the values of UV extinction, all of which remained high for a longer period. Comparing the results of the 2002 flood with the winter floods in 1995, 1999 and 2000, revealed increased values of As and Pb as well as higher concentrations of dissolved compounds. Keywords: river, flood, transport, suspended particulate matter, trace metals, dissolved compounds, Elb

The effects of meson mixing on dilepton spectra

The effect of scalar and vector meson mixing on the dilepton radiation from hot and dense hadronic matter is estimated in different isospin channels. In particular, we study the effect of $\sigma$-$\omega$ and $\rho-a_0$ mixing and calculate the corresponding rates. Effects are found to be significant compared to standard $\pi$-$\pi$ and $K$-${\bar K}$ annihilations. While the mixing in the isoscalar channel mostly gives a contribution in the invariant mass range between the two-pion threshold and the $\omega$ peak, the isovector channel mixing induces an additional peak just below that of the $\phi$. Experimentally, the dilepton signals from $\rho$-$a_0$ mixing seem to be more tractable than those from $\sigma$-$\omega$ mixing.Comment: 10 pages, 9 figure

Doubly Illegal: Qualitative Accounts of Underage Alcohol Access Through Theft

This study investigated sources of alcohol for underage drinkers. In-depth, semi-structured interviews were individually conducted with 47 youths, ages 15-18, who reported drinking within the last 12 months, to explore alcohol access. Theft was one method that some youths reported using to obtain alcohol. In addition to 9% of respondents who reported stealing alcohol from commercial outlets themselves, a total of 26% respondents reported occasions when their close friends stole alcohol. Our findings unveiled that teens had a body of knowledge that some drew upon for stealing alcohol. Youths revealed detailed knowledge about store layout, theft protection devices and store policies. In particular, respondents disclosed knowledge about which aisles have blind spots, how to remove security tops on bottles, and nochase policies. Theft of alcohol from commercial sources may be reduced by examining the weaknesses of existing theft prevention practices, and revising store policies

Studying the ω\omega properties in pA collisions via the ω→π0γ\omega{\to}\pi^0\gamma decay

Within transport calculations we study the production and decay of $\omega$-mesons in $pA$ reactions at COSY energies including elastic and inelastic ${\omega}N$ rescattering, the $\omega{\to}\pi^0\gamma$ Dalitz decay as well as $\pi^0 N$ rescattering. The resulting invariant $\pi^0 \gamma$ mass distributions indicate that in-medium modifications of the $\omega$-meson may be observed experimentally.Comment: 5 pages, espcrc2-style, including 5 ps-figure

Low autocorrelated multi-phase sequences

The interplay between the ground state energy of the generalized Bernasconi model to multi-phase, and the minimal value of the maximal autocorrelation function, $C_{max}=\max_K{|C_K|}$, $K=1,..N-1$, is examined analytically and the main results are: (a) The minimal value of $\min_N{C_{max}}$ is $0.435\sqrt{N}$ significantly smaller than the typical value for random sequences $O(\sqrt{\log{N}}\sqrt{N})$. (b) $\min_N{C_{max}}$ over all sequences of length N is obtained in an energy which is about 30% above the ground-state energy of the generalized Bernasconi model, independent of the number of phases m. (c) The maximal merit factor $F_{max}$ grows linearly with m. (d) For a given N, $\min_N{C_{max}}\sim\sqrt{N/m}$ indicating that for m=N, $\min_N{C_{max}}=1$, i.e. a Barker code exits. The analytical results are confirmed by simulations.Comment: 4 pages, 4 figure

Prognostic relevance of disseminated tumor cells in the bone marrow and biological factors of 265 primary breast carcinomas

Introduction The prognostic significance of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has been demonstrated in many studies. Yet, it is not clear which of the primary tumors' biological factors predict hematogenous dissemination. We therefore examined `tissue micro arrays' (TMAs) of 265 primary breast carcinomas from patients with known bone marrow ( BM) status for HER2, Topoisomerase IIa ( Top IIa), Ki 67, and p53. Methods BM analysis was performed by cytospin preparation and immunocytochemical staining for cytokeratin (CK). TMAs were examined by immunohistochemistry (IHC) for HER2, Top IIa, Ki 67 and p53, and fluorescence in situ hybridization ( FISH) for HER2. Results HER2 ( 2+/ 3+) was positive in 35/167 (21%) cases ( FISH 24.3%), Top IIa (> 10%) in 87/187 (46%), Ki 67 in 52/ 184 (28%) and p53 (> 5%) in 61/174 cases (34%). Of 265 patients, 68 (25.7%) showed DTC-BM with a median of 2/2 x 106 cells ( 1 to 1,500). None of the examined factors significantly predicted BM positivity. Significant correlation was seen between HER2 IHC and Top IIa ( p = 0.06), Ki 67 ( p = 0.031), and p53 ( p <.001). Top IIa correlated with Ki 67 and p53, and Ki 67 also with p53 ( p = 0.004). After a median follow-up of 60.5 months ( 7 to 255), the presence of DTC-BM showed prognostic relevance for overall survival ( p = 0.03), whereas HER2 ( IHC, p = 0.04; FISH, p = 0.03) and Ki 67 ( p = 0.04) correlated with disease free survival, and HER2 with distant disease free survival ( IHC, p = 0.06; FISH, p = 0.05). Discussion The congruence of the examined factors' expression rates indicates a causal line of suppressor, proliferation, and mitosis markers, and growth factor receptors. Hematogenous tumor cell spread seems to be an independent process. The examination of these factors on DTC-BM is the aim of ongoing research

Interferometry signatures for QCD first-order phase transition in heavy ion collisions at GSI-FAIR energies

Using the technique of quantum transport of the interfering pair we examine the Hanbury-Brown-Twiss (HBT) interferometry signatures for the particle-emitting sources of pions and kaons produced in the heavy ion collisions at GSI-FAIR energies. The evolution of the sources is described by relativistic hydrodynamics with the system equation of state of the first-order phase transition from quark-gluon plasma (QGP) to hadronic matter. We use quantum probability amplitudes in a path-integral formalism to calculate the two-particle correlation functions, where the effects of particle decay and multiple scattering are taken into consideration. We find that the HBT radii of kaons are smaller than those of pions for the same initial conditions. Both the HBT radii of pions and kaons increase with the system initial energy density. The HBT lifetimes of the pion and kaon sources are sensitive to the initial energy density. They are significantly prolonged when the initial energy density is tuned to the phase boundary between the QGP and mixed phase. This prolongations of the HBT lifetimes of pions and kaons may likely be observed in the heavy ion collisions with an incident energy in the GSI-FAIR energy range.Comment: 16 pages, 4 figure