Thomas Zidek

Multidrug resistance markers P-glycoprotein, multidrug resistance protein 1, and lung resistance protein in non-small cell lung cancer : prognostic implications

PurposeThe aim of this retrospective study was to comparatively investigate the expression of the three drug-resistance genes P-glycoprotein (P-gp), multidrug-resistance protein 1 (MRP1), and lung resistance protein (LRP), in non-small cell lung cancer (NSCLC) tissues, and to assess possible associations with clinicopathologic features.MethodsTumor specimens from 126 patients were analyzed by immunohistochemistry and, in selected cases, by reverse transcriptase polymerase chain reaction (RT-PCR), and data were statistically analyzed by SPSS.ResultsThe mean expression levels of tumor tissues in the case of P-gp and LRP did not exceed the one of normal epithelia, while MRP1 was significantly enhanced in NSCLC. A weak association was observed between higher grading and P-glycoprotein expression ( p <0.08) as well as lower grading and MRP1 expression in the case of adenocarcinoma ( p <0.05). MRP1 levels were highest in TNM stage I and declined with advanced stage ( p <0.03). A significant association was found between high MRP1 levels and longer overall survival ( N =115, p <0.04), which was highly significant in the patient group never treated with chemotherapy ( N =77; p <0.007). P-gp expression was enhanced in those patients who had received chemotherapy before surgery ( p <0.05).ConclusionsOur data point towards a major role of MRP1 in the intrinsic treatment resistance of NSCLC and suggest, in addition, a significant activation of P-gp expression during chemotherapy.

Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadal hormone axis

OBJECTIVES To assess the impact of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) on the hypothalamic-pituitary hormone axis, we determined the endocrine changes after radical prostatectomy (RP) and transurethral resection of the prostate (TURP) for BPH and in a group of men with BPH followed up conservatively. METHODS Patients with PCa before RP (n = 49), those who underwent TURP for BPH (n = 51), and men with lower urinary tract symptoms for whom a wait-and-see strategy was chosen (n = 46) were included. Serum levels of total testosterone, luteinizing hormone, and follicle-stimulating hormone were determined at baseline and 6 and 12 months later in all patients. RESULTS No significant endocrine changes were observed in the wait-and-see and TURP groups 6 and 12 months after baseline. In contrast, luteinizing hormone increased from 5.2 to 8.9 mIU/mL (P = 0.0004) and follicle-stimulating hormone from 5.7 to 9.3 mIU/mL (P = 0.0003) 12 months after RP. The rise of total testosterone from 3.9 to 4.4 ng/mL failed to reach statistical significance (P = 0.18). Patients with Gleason score 2 to 6 PCa had higher testosterone values (4.2 ng/mL) at baseline than did those with Gleason score 7 to 10 PCa (2.2 ng/mL, P < 0.05). Although 12 months after RP no changes in testosterone were observed in the low Gleason score group, the testosterone levels more than doubled in those with high-grade tumors. The increases in luteinizing hormone and follicle-stimulating hormone at 12 months, however, were comparable in both groups. CONCLUSIONS Our findings suggest a significant impact of PCa on the hypothalamic-pituitary axis that is more profound in high-grade cancer. Such an effect was not demonstrable for the transition zone in BPH.

Cellular reaction on the anterior surface of 4 types of intraocular lenses

Purpose: To assess the cellular reaction on the anterior surface of 4 types of foldable intraocular lenses (IOLs). Setting: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. Methods: One hundred eyes scheduled for cataract surgery were prospectively randomized into 4 groups of 25 eyes each using random number tables. Group 1 received a Hydroview™ IOL (Bausch & Lomb), Group 2 an AcrySof® IOL (Alcon), Group 3 a MemoryLens® IOL (ORC), and Group 4 a CeeOn® 920 IOL (Pharmacia). Patients were examined 1, 3, 7, 30, 90, and 180 days postoperatively. Postoperative biomicroscopic examinations were done with a slitlamp, and a specular microscope was used to document the presence of cell deposits and identify areas with the highest density of cells. Results: The local tissue response revealed 2 patterns: a nonspecific foreign‐body reaction to the IOL (small round, fibroblast‐like, epithelioid, and giant cells) and a lens epithelial cell (LEC) reaction. The highest incidence of LECs was in the Hydroview group, in which LECs were present on 81.8% of lenses 180 days postoperatively. During the first postoperative days, small round and fibroblast‐like cells were found on all IOLs. From 7 days on, the incidence and density of these cells were less severe in the Hydroview and CeeOn 920 groups. After several weeks, epithelioid cells and foreign‐body giant cells were seen on some IOLs. These cells appeared more often on AcrySof, MemoryLens, and CeeOn IOLs. Conclusion: This study found IOL‐related differences in cellular reaction after cataract surgery. The incidence of a nonspecific foreign‐body reaction to 4 IOLs is consistent with the results of previous studies. The incidence of LECs was highest in the Hydroview group and lowest in the AcrySof group. The CeeOn 920 group had the lowest incidence of all types of cells.

Symptoms suggestive of atopic rhinitis in children aged 6–9 years and the indoor environment

Background: We aimed to investigate the influence of indoor factors on the prevalence of symptoms suggestive of atopic rhinitis in children aged 6–9 years in Upper Austria.

A cohort mortality and nested case-control study of French and Austrian talc workers

Objectives: To study whether the mortality from non-malignant and malignant respiratory diseases of workers employed in French and Austrian talc mines and mills is related to their long term occupational exposure. Methods: Two historical cohorts were set up comprising all male subjects who had been working continuously for at least 1 year in a series of talc producing companies in France and Austria. The French cohort consisted of those employed at a site in the French Pyrenees and working between 1 January 1945 and 31 December 1994. The Austrian cohort consisted of the workers employed between 1 January 1972 and 31 December 1995 in one of four industrial sites in the Austrian Alps. The mortality within the cohorts was compared with local death rates. Two nested case-control studies focusing on non-malignant and malignant respiratory diseases were set up to estimate possible dose-response relations with cumulative exposure to talc dust based on an industry specific job exposure matrix. Results: Mortality from lung cancer was in small excess in both cohorts (France, standardised mortality ratio (SMR) 1.23, 21 cases observed, 95% confidence interval (95% CI) 0.76 to 1.89; Austria, SMR 1.06, seven observed, 95% CI 0.43 to 2.19). A non-significant excess mortality was found for all non-malignant respiratory diseases in the French cohort due to a significant excess for pneumoconiosis (SMR 5.56, three observed, 95% CI 1.12 to 16.2). The case-control study of non-malignant respiratory disease showed an increased mortality in the highest exposure groups (odds ratio (OR) 2.5 for a cumulative exposure ≥800 y.mg/m3) with a significant trend (OR/100 y.mg/m3 1.08) with cumulative exposure to talc. On the contrary, no increasing trend could be found in the case-control study of lung cancer. This result must be interpreted considering the small cohort size. Adjustment on smoking and exposure to quartz did not influence these results to any extent. Conclusions: The mortality from non-malignant respiratory disease was found to be related to high cumulative exposure to talc dust. The small excess in lung cancer does not seem to be attributable to talc.

Breaking bad news to cancer patients: survey and analysis.

Purpose: To find out how patients perceived the disclosure of news about their cancer as regards the physician counselling and how they perceived the flow of information between hospital‐based and family physicians.

MORPHOLOGICAL AND FUNCTIONAL RESULTS OF ACRYSOF INTRAOCULAR LENS IMPLANTATION IN CHILDREN: PROSPECTIVE RANDOMIZED STUDY OF AGE-RELATED SURGICAL MANAGEMENT

Purpose: To evaluate the prevalence and severity of posterior capsule opacification (PCO) in pediatric eyes with a foldable acrylic AcrySof® (Alcon) intraocular lens (IOL) and age‐related surgical methods. Setting: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. Methods: This prospective randomized study comprised 50 eyes of 34 children aged between 2 and 16 years. Eyes of children between 2 and 5.9 years were consecutively randomized to Group 1a (primary posterior capsulotomy and anterior vitrectomy) or Group 1b (optic capture in addition). Eyes of children between 6 and 16 years were consecutively randomized to Group 2a (primary posterior capsulotomy without anterior vitrectomy), Group 2b (optic capture in addition), or Group 2c (in‐the‐bag IOL implantation without opening the posterior capsule). Main outcome parameters were the incidence and severity of PCO formation, early postoperative complications, pigmented cell deposits on the IOL surface, and cataract morphology. Results: The visual axis was clear at the last follow‐up in all eyes in Groups 1a, 1b, 2a, and 2b except in 1 eye in Group 1a. Sixty‐percent of eyes in Group 2c had PCO. The incidence of early postoperative complications was significantly higher in eyes that developed PCO than in those that maintained a clear visual axis. There was no evidence that cataract morphology influenced PCO rates. Conclusions: The AcrySof IOL was well tolerated in pediatric eyes. Optic capture was not necessary to ensure a clear visual axis. Primary posterior capsulotomy should be performed in preschool and uncooperative children and in eyes expected to have relatively high postoperative inflammation. Implanting the AcrySof in the bag and leaving the posterior capsule intact is acceptable for school children and juveniles with isolated developmental cataract.

High-altitude retinopathy and retinal vascular dysregulation.

Purpose (a) To show that high-altitude retinopathy (HAR) is common at high altitudes even in well-acclimatised climbers and that it should not be regarded as part of the spectrum of benign mountain sickness but rather as a clinical sign with a separate aetiology. (b) To test the hypothesis that HAR could be interpreted as a clinical expression of ‘ocular vascular dysregulation.Methods Both eyes of the 8 mountaineers of the First Vienna Himalayan Expedition in May/June 1996 were examined 2 weeks before departure to and 2 weeks after descent from a high altitude. Retinal blood flow was measured in the right eyes of 7 climbers, using the Heidelberg Retina Flowmeter (HRF).Results Two of the 8 climbers had bilateral retinal haemorrhage after the expedition. In 5 climbers chronic hypoxic exposure caused an increase in retinal blood flow between +18% and +96%, and in 2 climbers a decrease in retinal blood flow between -21% and -31%. The 2 climbers (climbers 1 and 2) with bilateral retinal haemorrhage showed a significant increase in HRF parameters.Conclusions HAR may be a clinical sign of mountaineers with a tendency towards ocular vascular dysregulation. The pronounced increase in all haemodynamic parameters in the 2 climbers with retinal haemorrhage combined with a dilated epipapillary network 2 weeks after the exposure reflects a retinal vessel configuration, as might be expected at high altitudes under acute hypoxic stress. An inadequate autoregulatory response of the retinal circulation under conditions of chronic hypoxia may play an important part in the pathogenesis of HAR.

Complementary therapies in cancer patients: prevalence and patients' motives

ZusammenfassungHintergrundAus einer Reihe europäischer Länder sind Daten hinsichtlich der Inanspruchnahme komplementärmedizinischer Methoden durch onkologische Patienten bekannt. Für Österreich liegen keine aktuellen Daten zu dieser Fragestellung vor.ZielIn Erfahrung zu bringen, wie verbreitet der Einsatz komplementärer Behandlungsmethoden ist. aufgrund welcher Motive Krebspatienten diese anwenden, welche Methoden eingesetzt werden und wer die Behandler sind.StudiendesignQuerschnittsstudie.Patienten und Methode231 Patienten, welche die Wiener Krebshilfe aufsuchten, wurden mittels Fragebogen exploriert. Die statistische Auswertung erfolgte mittels Chi-Quadrat- und Mantel-Haenszel-Test.Ergebnisse27,3% hatten eine komplementäre Therapie erhalten. Das waren 33,1% aller weiblichen und 20,5% aller männlichen Krebspatienten (p=0,045). Jene Patienten, die unter dem Median der Altersverteilung (53,8 Jahre) lagen, hatten statistisch signifikant häufiger komplementäre Methoden in Anspruch genommen (35,5% vs. 21,1%; p=0,023). Die wichtigsten Motive waren „Unterstützung der natürlichen Heilung” und Empfehlung durch den Hausarzt. Komplementäre Methoden wurden in 44,4% vom Hausarzt, in 39,7% von den Patienten selber, in 6,3% vom einem Spitalsarzt, in 6,3% „vom medizinischen Laien oder Heilpraktiker gegen Entgelt” und in 4,8% vom niedergelassenen Facharzt angewandt.SchlussfolgerungenAufgrund des hohe Prozentsatzes von Krebspatienten, die komplementäre Methoden ohne Konsultation eines Arztes anwenden oder dies aufgrund der Empfehlung anderer tun, erscheint es wahrscheinlich, dass deren Einsatz häufig nicht mit der konventionellen onkologischen Therapie abgestimmt ist. Um dem abzuhelfen, sollten Onkologen und Allgemeinärzte grundlegende Kenntnisse der Komplementärmedizin und ihrer Methoden haben. Bei der Patientenberatung sollte die Frage der Anwendung komplementärer Methoden angesprochen werden.SummaryBackgroundData relating to the use of complementary/alternative medicine (CAM) in cancer patients have been published for a number of European countries. No recent data are available for Austria.AimTo ascertain the extent of CAM use by cancer patients, what patients’ motives are, what methods are used and who the CAM providers are.DesignSelf-administered questionnaire; cross-sectional study.Patients and methodsA sample of 231 cancer patients who had consulted the Viennese Cancer League. Chi-square and Mantel-Haenszel tests were used for the statistical evaluation.Results27.3% of the cancer patients had received CAM therapy: 33.1% of the female and 20.5% of the male participants (p=0.045). Those who were below the median of the age categories (53.8 years) had used CAM to a statistically higher degree (35.5% vs. 21.1%; p=0.023). The most important motives were the enhancement of “nature” and the GPs’ recommendation. CAM was administered in 44.4% of cases by the family doctor, in 39.7% by patients themselves, in 6.3% by a hospital doctor, in 6.3% by a lay-practitioner or “non-medical practitioner against payment” and in 4.8% of cases by a practising oncologist.ConclusionFrom the high percentage of patients who use CAM without consulting a physician or who follow the advice of others, it would seem highly probable that conventional and complementary methods are rarely effectively coordinated. To rectify this we conclude that oncologists and GPs should have a basic knowledge of CAM and address the issue when counselling their cancer patients.

Atopische Prädisposition des Kinds und andere das Stillverhalten beeinflussende Faktoren

ZusammenfassungHintergrund und Methode: Im Rahmen einer ISAAC(International Study of Asthma and Allergy in Childhood)-Vollerhebung in Oberösterreich wurden die Stillgewohnheiten von Müttern und die Auswirkung des Stillverhaltens auf das Auftreten atopischer Erkrankungen der Kinder bis zum Alter von 6–9 Jahren analysiert. Ergebnisse: Insgesamt gaben 74,6% der Eltern (retrospektiv mittels Fragebogen) Stillen als Ernährungsform ihrer Kinder an; jeweils 25,9% der Kinder wurden weniger als 2 Monate bzw. 2–4 Monate ausschließlich mit Muttermilch ernährt, an die empfohlene Stilldauer von 5–6 Monaten hielten sich 13,2% der Mütter und 10,4% der Kinder wurden mehr als 6 Monate gestillt. Rauchen der Mutter und niedrige Bildung der Eltern zeigten eine signifikant inverse Beziehung zu Stillprävalenz und Stilldauer. 23,8% der Kinder wurden als Risikokinder (1 Verwandter 1. Grads mit zumindest einer atopischen Erkrankung) eingestuft, 7,2% der Kinder wurden als Hochrisikokinder (mehr als 1 Verwandter 1. Grads mit atopischer Erkrankung) bezeichnet. Diskussion: Im Vergleich zu Kindern ohne familiäre Belastung wurden Risikokinder und Hochrisikokinder signifikant häufiger und länger gestillt. Eine protektive Wirkung des Stillens konnte allerdings nur für das Auftreten einer allergischen Rhinitis festgestellt werden. Zwischen Stillverhalten bzw. Stilldauer und dem Auftreten von Asthma bronchiale und atopischem Ekzem bis zum Alter von 6–9 Jahren konnte kein signifikanter Zusammenhang gefunden werden.SummaryBackground and methods: As part of the population – based ISAAC (International Study of Asthma and Allergy in Childhood) study conducted in Upper Austria we analyed breastfeeding and its effects on the development of atopic diseases in children up to the age of 6–9 years. Results: 74.6% of the parents reported breastfeeding their children; 25.9% of the children were breastfed for less than 2 months, 25.9% for 2 to 4 months, the recommended duration of exclusive breastfeeding for 5–6 months was followed by 13.2% of the mothers, and 10.4% of the children were exclusively breastfed for more than 6 months. Smoking during pregnancy and low educational level were inversly related to breastfeeding and the duration of exclusive breastfeeding. 23.8% of children were classified risk-children (one first grade relative with at least one atopic disease), 7.2% of children were classified high-risk children ( more than one first grade relative with an atopic disease). Discussion: In comparison to children without family predisposition, risk and high risk-children were breastfed both more often and also for a longer period of time. A protective effect of breastfeeding was only found for the prevalence of allergic rhinitis. We found no significant relation between asthma or atopic eczema and breastfeeding and dura-tion of exclusive breastfeeding respectively.