U. Ulrich

Cross-linked type I collagen C- and N-telopeptides in women with bone metastases from breast cancer

Abstract This study documents values of biochemical markers of bone remodeling in 106 patients with breast cancer. Based on scintigraphic and radiological findings, patients were divided into 3 groups: 19 patients with bone metastases, 65 patients without bone metastases and normal bone scintigrams, and 22 patients with pathological, non-malignant findings on scintigraphy without proof of bone metastases. Urinary cross-linked type I collagen N-telopeptides (NTx) and serum cross-linked type I collagen C-telopeptides (ICTP) were assessed as markers of bone resorption. Bone alkaline phosphatase (BAP) was assessed as a marker of bone formation. All three markers were significantly higher in patients with bone metastases compared to both patients without skeletal recurrence and those with pathological, non-malignant scintigraphic findings (p < 0.01). There were no statistically significant differences between the latter two groups. The clinical sensitivity for diagnosing bone metastases was 44% for NTx, 65% for ICTP, and 26% for BAP, respectively. The clinical specificitiy for discriminating patients with bone disease from those without were 79%, 91%, and 92% for NTx, ICTP, and BAP, respectively. In conclusion, markers of bone remodeling are increased in patients with breast cancer metastatic to the skeleton. The sensitivity of the markers presented in this paper did not seem to be sufficient enough for early identification of patients with subclinical bone recurrence in a clinical practice setting.

Bowenoid papulosis of the vulva—immunotherapeutical approach with topical imiquimod

Introduction.Bowenoid papulosis is a characteristic lesion of the ano-genital region and represents a form of squamous cell carcinoma in situ, very often associated to the oncogenic high-risk human papilloma virus (HPV) types 16, 18, 31 and 33. Therapies applied so far, in general, show high rates of relapse, and patients complain of pruritus and pain. Imiquimod cream is a topical immune response modifier with indirect antiviral and antitumor effects through the stimulation of local cytokine production and cell-mediated immune response.Case report.In the present paper we report on the topical application of imiquimod cream in a woman with a high-risk HPV-associated vulvar intraepithelial neoplasia grade III (VIN III) of the vulva.DiscussionIn addition a review of the literature is given.

Terminal ileitis with sealed perforation—a rare complication of intestinal endometriosis: case report and short review of the literature

IntroductionPerforation is a rare complication of intestinal endometriosis. We report on a 38-year-old patient with previously known rectovaginal and ileocecal endometriosis who was referred with an acute abdomen.Case reportOn abdominal plain film an ileus of small intestine was diagnosed. The patient had fever, and the C-reactive protein was markedly increased. Upon emergency laparotomy an acute terminal ileitis with omentum-sealed perforation and a stenosis of the anterior wall of the rectum due to endometriosis were found. Partial resection of the ileum with end-to-end anastomosis, appendectomy, and short segmental rectum resection were performed. The postoperative course was uneventful. Histological examination corroborated the intraoperative diagnosis of fistulas, perforation and deep ulceration of the intestine consistent with transmural endometriosis.DiscussionFor proper care of these patients excellent cooperation between gynecologists and general surgeons is desirable. A short review of the literature concerning intestinal endometriosis is given.

Photoradiation of perfused placental tissue – a suitable in vitro model for photodynamic therapy?

Abstract Our aim was to evaluate the isolated placental lobule as a model to study the cytotoxic effects of photodynamic therapy (PDT) in vitro. Ten human placental lobules were dually perfused with a modified medium 199 for a 4-hour period. Photosan III was added to the fetal perfusate at a dose of 5 mg/kg tissue, and laser light (630 nm wavelength) provided by an argon-pumped dye laser was applied at 50 J/cm2 in the experimental group (n=5). Potassium and lactate dehydrogenase (LDH) release into the perfusate as well as the transplacental creatinine passage from PDT-treated placentas and control placentas (n=5) were compared, and light microscopic examinations of the placental tissue were performed after the experiments. Potassium release into the fetal perfusate was higher in the PDT-treated placental lobules (p<0.05), and weight gain during the artificial perfusion suggests the development of edema only in the photoradiated lobules (p<0.01). The release of the bigger molecules of the LDH however was comparable in the two experimental groups, and transplacental creatinine passage was not affected by photoradiation. Light microscopic examinations demonstrated lesions at the cytotrophoblast, the syncytiotrophoblast and the endothelium of the fetal vessels of the photoradiated placentas, although they were not specific and could also be found in the control tissue. We conclude that the isolated placenta may be used to study cytotoxic effects of photoradiation in vitro, but better specifity and sensitivity might be achieved if a. The perfusion time is prolonged to make the difference between the experimental and the control group clearer and b. Electron microscopic investigations are made to demonstrate intracellular lesions of the mitochondria and the endoplasmic reticulum.

Comment on the LACC Trial Investigating Early-stage Cervical Cancer by the Uterus Commission of the Study Group for Gynecologic Oncology (AGO) and the Study Group for Gynecologic Endoscopy (AGE) of the German Society for Gynecology and Obstetrics (DGGG)

Affiliations 1 Universitätsfrauenklinik Hannover, Hannover, Germany 2 Universitätsfrauenklinik Tübingen, Tübingen, Germany 3 Frauenklinik, Krankenhaus St. Elisabeth gGmbH, Damme, Germany 4 Frauenklinik, Diakonie Kaiserswerth, Düsseldorf, Germany 5 Universitätsfrauenklinik Jena, Jena, Germany 6 Frauenklinik, Martin-Luther-Krankenhaus, Berlin, Germany 7 Universitätsfrauenklinik Heidelberg, Heidelberg, Germany 8 Universitätsfrauenklinik Homburg, Homburg, Germany 9 Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany 10 Universitätsfrauenklinik der Ruhr-Universität Bochum, Bochum, Germany