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This is the second part of a two‐part article in which we focus on the ultrasound (US) appearance of the pathological ulnar nerve (UN) and its main branches. Findings in a wide range of our pathological cases are presented with high‐resolution US images obtained with the latest‐generation US machines and transducers.

This is the first of a two‐part article in which we focus on the ultrasound (US) appearance of the normal ulnar nerve (UN) and its main branches. The detailed US anatomy of the UN course is presented with high‐resolution US images obtained with the latest‐generation US machines and transducers.

IMPORTANCE: The role of axillary lymph node dissection (ALND) to determine nodal burden to inform systemic therapy recommendations in patients with clinically node (cN)–positive breast cancer (BC) is currently unknown. OBJECTIVE: To address the association of ALND with systemic therapy in cN-positive BC in the upfront surgery setting and after neoadjuvant chemotherapy (NACT). DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, observational, cohort study conducted from August 2018 to June 2022. This was a preplanned study within the phase 3 randomized clinical OPBC-03/TAXIS trial. Included were patients with confirmed cN-positive BC from 44 private, public, and academic breast centers in 6 European countries. After NACT, residual nodal disease was mandatory, and a minimum follow-up of 2 months was required. EXPOSURES: All patients underwent tailored axillary surgery (TAS) followed by ALND or axillary radiotherapy (ART) according to TAXIS randomization. TAS removed suspicious palpable and sentinel nodes, whereas imaging-guidance was optional. Systemic therapy recommendations were at the discretion of the local investigators. RESULTS: A total of 500 patients (median [IQR] age, 57 [48-69] years; 487 female [97.4%]) were included in the study. In the upfront surgery setting, 296 of 335 patients (88.4%) had hormone receptor (HR)–positive and Erb-B2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)–negative disease: 145 (49.0%) underwent ART, and 151 (51.0%) underwent ALND. The median (IQR) number of removed positive lymph nodes without ALND was 3 (1-4) nodes compared with 4 (2-9) nodes with ALND. There was no association of ALND with the proportion of patients undergoing adjuvant chemotherapy (81 of 145 [55.9%] vs 91 of 151 [60.3%]; adjusted odds ratio [aOR], 0.72; 95% CI, 0.19-2.67) and type of systemic therapy. Of 151 patients with NACT, 74 (51.0%) underwent ART, and 77 (49.0%) underwent ALND. The ratio of removed to positive nodes was a median (IQR) of 4 (3-7) nodes to 2 (1-3) nodes and 15 (12-19) nodes to 2 (1-5) nodes in the ART and ALND groups, respectively. There was no observed association of ALND with the proportion of patients undergoing postneoadjuvant systemic therapy (57 of 74 [77.0%] vs 55 of 77 [71.4%]; aOR, 0.86; 95% CI, 0.43-1.70), type of postneoadjuvant chemotherapy (eg, capecitabine: 10 of 74 [13.5%] vs 10 of 77 [13.0%]; trastuzumab emtansine–DM1: 9 of 74 [12.2%] vs 11 of 77 [14.3%]), or endocrine therapy (eg, aromatase inhibitors: 41 of 74 [55.4%] vs 36 of 77 [46.8%]; tamoxifen: 8 of 74 [10.8%] vs 6 of 77 [7.8%]). CONCLUSION: Results of this cohort study suggest that patients without ALND were significantly understaged. However, ALND did not inform systemic therapy recommendations.

We review the ultrasound (US) findings in patients who present with meralgia paresthetica (MP). The anatomy of the lateral femoral cutaneous nerve at the level where the nerve exits the pelvis and potential entrapment sites that can lead to MP are discussed. A wide range of pathological cases are presented to help in recognizing the US patterns of MP. Finally, our experience with US‐guided treatment is discussed.

This pictorial review focuses on the ultrasound (US) appearance of the normal and pathological radial nerve (RN) and its branches and provides tips with which to locate them and avoid misinterpretation of normal findings. A wide range of our pathological cases are reviewed and presented to help in familiarizing the reader with common and uncommon clinical scenarios that affect the RN and its main branches.

Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common peroneal nerve. The DPN may be affected by various disorders, which may be clinically challenging to show. This Pictorial Essay reviews the normal ultrasound anatomy of the DPN and presents disorders that may involve the nerve and its main branches along its course, from proximal to distal.

AbstractGrowth performance and meat quality traits of 24 Massese suckling lambs reared up to 69 days of age in different farming systems were evaluated. Three groups were considered: stall (S) reared indoors and fed concentrate and hay; pasture (P) reared outdoor and fed pasture and hay; semi free-range (F) reared indoors during the night and at pasture during the day, fed concentrate, hay and herbage. The lambs remained constantly with their dams for the whole period, having thus always access to mothers’ milk. Animals weights were recorded, and, after slaughtering, carcase traits were considered. Fatty acids composition and chemical/physical parameters of milk and meat were analysed. Lambs growth was similar in the first 30 days, while afterwards differences emerged: P lambs recorded the worst values reaching slaughter weight of 14.6 kg versus 22.3 and 22.7 of the S and the F group, respectively. Carcase of P lambs resulted less fat and with a lower lean/bone ratio than the other groups (1.8, 2.1 and 2.3 for P, S and F, respectively). Fatty acids composition of ewes’ milk had effect on lambs’ meat profile, probably because they continued to suck milk until slaughter. Moreover, also farming system affected fatty acids profile of lambs’ meat: grazing animals, especially P, showed the highest PUFA and the lowest SFA percentage and P meat showed the best composition for human health. As regards physical traits, F meat was more coloured than P and S meat, while P meat was less tender than others.HighlightsTwo-month-old Massese lamb is a marketable product.Suckled milk affected lambs’ meat composition also at later ages.Pasture in lambs’ diet increases PUFA content in the meat.

Disorders of retinacula are frequent in acute and repetitive microtrauma of the ankle. Ultrasound (US), thanks to its spatial resolution and dynamic capabilities, is routinely used in the evaluation of the posttraumatic ankle for accurate delineation of ligaments and tendons. In addition, US can provide a depiction of normal retinacula and a detailed assessment of their pathologic changes. An accurate US assessment of ankle retinacula is helpful in choosing the proper treatment. In this pictorial essay, we briefly review the normal anatomy of ankle retinacula, describe their normal US appearance, and present a wide range of US pathologic abnormalities.

Research and management programs of wild animal populations often require intensive field actions, which make direct interventions on animals such as capture, immobilization and manipulation, frequently necessary. Such events, however, could induce a stress response causing physiological and behavioural alterations in the individuals. Knowing the impact of these practices in the post-release phase is of crucial importance when studying the spatial behaviour of wild species. Our study aimed to investigate the potential effect of narcosis and application of GPS collars on 17 red deer Cervus elaphushinds living in a mountainous area in northern Apennine, Italy. We conducted the analysis at a temporal scale of 45 days after release, in order to assess the response of animals in terms of changes in movement rates, distance from the barycentre of their positions and distance from the capture sites. We then compared habitat selection between the period of disturbance and the following days. This work represents the first study of the behavioural responses of wild red deer to capture and handling procedures. We showed that these operations significantly affect the spatial behaviour of hinds by inducing a short-term increase in movement rates and by keeping the animals away from the centre of their activity, for a period no longer than 10 days. The habitat selection analysis remarked a tendency to escape from human disturbance, by avoiding hunting sites and anthropized locations in favour of forest cover. Red deer hinds thus, seem to cope with stressful events and disturbance by adopting a flight behaviour, which includes moving away from the capture area and seeking refuges. The differences highlighted between the ‘stressful’ period and the following one, showed that such modifications persist for a limited time frame and suggested that this capture method is unlikely to lead to permanent alterations of behaviour.

The persistence in therapy of rheumatoid arthritis drugs and particularly bDMARD is a limiting factor for their long-term use. The randomized controlled trials (RCTs) may not reflect real-world contexts due to strict inclusion and exclusion criteria. Baricitinib, which targets both JAK1 and JAK2, has been used in Italy for several years. The aim of this multi-center study is to assess the real world persistence on therapy of baricitinib in RA patients and to identify predictive factors of baricitinib's survival rate.

Ultrasound is a well‐proven imaging modality for showing peripheral nerve disorders and guiding perineural injections. The aim of this review is to focus on small peripheral nerve abnormalities, which are usually not recognized by sonologists. In fact, most of these small nerves have a tiny diameter (<2 mm), and their anatomy is less familiar. We describe the most common causes of small peripheral nerve disorders, providing an accurate description of their anatomic locations and relationships with adjacent structures; we also focus on technical hints that may help in their evaluation.

Calcific tendinopathy (CTe) is a frequent disorder related to the deposition of calcium hydroxyapatite crystals within tendons. Ultrasound has been shown to be an excellent imaging modality for the evaluation of CTe. During the resorptive phase of CTe, calcium deposits may migrate inside the tendons or in neighboring tissues and lead to local inflammation and severe pain. In this pictorial essay, we describe the ultrasound appearance of a spectrum of CTe migrations. Knowledge of the different migration patterns can help sonologists in their detection and in establishing the correct diagnosis.

ABSTRACTIntroduction: Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease, which affects joints and extra-articular structures. Nowadays, the armamentarium of therapeutic options is progressively expanding and embraces several mechanisms of action: TNF inhibition, B-cell depletion, T-cell co-stimulation inhibition, IL-6 blockade, and JAK-inhibition. Granulocyte-Monocyte-Colony-Stimulating-Factor (GM-CSF) is a mediator acting as a cytokine with a proven pathogenetic role in RA, providing a potential alternative target for the management of the disease. Mavrilimumab is a monoclonal antibody against GM-CSF receptor, which has been successfully tested in RA patients.Areas covered: Beginning with a description of the preclinical evidence and the rationale for GM-CSF blockade in RA, this review will provide a wide overview of mavrilimumab efficacy and safety profile by analyzing phase I/II RCTs conducted in patients with moderate to severe RA.Expert opinion: According to the promising results from phase I-II RCTs, mavrilimumab could be considered as an additional therapeutic option for RA patients multi-resistant to the available targeted drugs. However, the optimal dose and the profile of this new drug should be confirmed in phase III RCTs before the marketing.Trial registration:ClinicalTrials.gov identifier: NCT01706926.Trial registration:ClinicalTrials.gov identifier: NCT01715896.Trial registration:ClinicalTrials.gov identifier: NCT01712399.Trial registration:ClinicalTrials.gov identifier: NCT00771420.Trial registration:ClinicalTrials.gov identifier: NCT01050998.

The hamstring muscle complex is made by a group of posterior biarticular thigh muscles, originating at the ischial tuberosity, which extend the hip and flex the knee joint. Proximal hamstring injuries are frequent among athletes, commonly involving their long myotendinous junction during an eccentric contraction. In this pictorial essay, we describe the ultrasound technique to visualize the normal anatomy of the proximal hamstring muscle‐tendon‐bone complex and present ultrasound findings in patients with traumatic injuries and tendinopathies.

To evaluate the 8‐year survival of the first tumor necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (SpA) or psoriatic arthritis (PsA), identify the predictive factors for withdrawal, and compare the discontinuation rates for infliximab, etanercept, and adalimumab. We evaluated PsA and axial SpA patients treated with a first‐line TNFi between 2005 and 2015 at 4 Italian tertiary centers. Eight‐year drug survival was calculated by the Kaplan‐Meier method, and risk for discontinuation among treatment groups compared by stratified log‐rank test. Univariate and multivariate Cox proportional hazard models were developed to examine predictors of withdrawal. Of 614 patients (316 axial with SpA, 298 with PsA), 203 received adalimumab, 131 etanercept, and 280 infliximab, with similar frequencies in axial SpA and PsA subgroups. The cumulative 8‐year retention rate in the whole population was 55.1% (57.2% and 51.9% for axial SpA and PsA, respectively; P= not significant). No significant differences were observed in drug persistence among individual TNFi in either group. Male sex (hazard ratio [HR] 0.595 [95% confidence interval (95% CI) 0.405–0.875]; P= 0.008) and concomitant methotrexate use (HR 0.648 [95% CI 0.426–0.985]; P= 0.042) were associated with a lower risk of withdrawal in PsA. High baseline Bath Ankylosing Spondylitis Disease Activity Index (HR 0.9842 [95% CI 0.9708–0.9980]; P= 0.028) was associated with a lower risk of withdrawal in axial SpA. No difference was found in the comparative analysis of reasons for discontinuation between PsA and axial SpA. We reported that the real‐life 8‐year retention rate of the first TNFi in axial SpA and PsA is greater than 50%, with no significant differences between axial SpA and PsA, irrespective of the individual TNFi.

Objective.To study, in a real-life setting, the construct validity, the reliability, and the interpretability of the 12-item Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire in patients with psoriatic arthritis (PsA).Methods.In 144 consecutive patients with PsA (81 men and 63 women, mean age of 51.4 ± 12.8 yrs, and 77 receiving biologic treatment), the PsAID-12 and other patient-reported outcomes (PRO) were collected, such as the Dermatology Life Quality Index. Each patient underwent articular and skin assessment.Results.Construct validity: Factor analysis revealed a 2-factor result defined as the PsAID Symptom Score and the PsAID Skin Score. In determining convergent validity, significant correlations were found between the PsAID-12 and the clinical Disease Activity index for Psoriatic Arthritis (cDAPSA; ρ = 0.867, p < 0.0001). Multivariable analysis showed that the PsAID-12 is determined by the articular disease activity (cDAPSA, p < 0.0001), severity of psoriasis (PsO; physician’s global assessment, p < 0.0001), and the presence of a coexisting fibromyalgia (FM; p < 0.0001). Reliability: Cronbach’s alpha coefficient was 0.93 for the total PsAID-12. Interpretability: Applying the cDAPSA categorization of disease activity states, the PsAID-12 cutoff values resulted in 1.4 between remission and low disease activity (LDA), 4.1 between LDA and moderate disease activity (MDA), and 6.7 between MDA and high disease activity.Conclusion.The PsAID-12 is an excellent PRO to evaluate the effect of PsA. It should be carefully handled in patients with coexisting FM.

Objective In a real-life setting, to analyse retrospectively the effects of different methotrexate regimens on etanercept efficacy during the first year of treatment for rheumatoid arthritis (RA).Methods Demographic characteristics, clinical parameters and treatment data from patients with RA receiving the first-line biological disease-modifying antirheumatic drug, etanercept, as monotherapy or in combination with methotrexate were analysed at baseline and after 6 and 12 months. The study population was stratified into three groups according to the level of concomitant methotrexate therapy: no methotrexate, low-dose methotrexate (≤ 10 mg/week) or high-dose methotrexate (>10 mg/week).Results Clinical response at 6 and 12 months and clinical outcome at 12 months were significantly better in patients concomitantly treated with high-dose methotrexate. Furthermore, this regimen was associated with the lowest discontinuation rate, suggesting a favourable safety profile.Conclusion These data confirm, in a real-life setting, the importance of methotrexate as a combination therapy with etanercept and suggest that the minimal effective dose of methotrexate is >10 mg/week.

AbstractMorphometric studies on European red deer (Cervus elaphusL.) living in sub-Mediterranean areas are rare. In this paper, we provide the first morphometric description of red deer from Apennine living in Prato Province, as well as a description of its skeletal growth pattern. We analysed 18 body, cranial and antler measurements from 905 deer carcasses, collected during 12 hunting seasons (2000–2012). The body size of red deer from Prato appeared comparable to that of other populations from Northern Apennine and Central Alps. A significant variation in weight during the hunting season was detected only in adult stags: they were estimated to lose 23% of their eviscerated body weight from the beginning of the rutting season until the end of winter. The relationship between eviscerated body weight (EW) and whole body weight (WW) was highly significant in both sexes within every age class (R2always higher than 0.75), thus linear regressions were assessed in order to estimate EW from WW, allowing to complete datasets when such information is missing. Growth equations were utilised to describe the development of a subset of skeletal measures (height at shoulder, hind foot length, mandible length, head–trunk length) commonly collected on hunted cervids. Hind foot length was the measure which first ceased to grow and with the highest growth constant; although the relationship between cohort hind foot length and environmental, climatic and demographic variables has to be tested for red deer from Apennine, these bones appeared a suitable biological indicator for long-term monitoring of the species.

There is an increasing emphasis on using cost-effectiveness analysis to achieve a higher value for the money invested in the healthcare, avoiding waste and unnecessary costs. The process for achieving a better use of available resources should include five steps: collecting data, developing indicators, evaluating evidence, making informed decisions, and considering consequences. Clinical laboratories represent a paradigmatic model to improve data collection in order to develop further steps of the improvement process. Here we describe the experience of the “e-Valuate” project, aiming to improve the collection of laboratory data to provide useful information that should be the foundation for all other steps of this improvement project.

To evaluate the 12‐year survival of the first tumor necrosis factor inhibitor (TNFi) treatment in a cohort of rheumatoid arthritis (RA) patients, comparing the between‐groups discontinuation rates for infliximab, etanercept, and adalimumab. RA patients treated with their first TNFi were investigated from a local registry. Before and after adjusting for propensity scores, overall and by individual TNFi 12‐year drug retention was evaluated. Drug survival rates were calculated using the Kaplan‐Meier method and compared by the Cox extended model. Subanalyses were performed according to concomitant methotrexate (MTX) and discontinuation reasons. Of 583 patients, 222 were treated with infliximab, 179 with etanercept, and 182 with adalimumab; 33.7% and 26% discontinued the first TNFi because of inefficacy or adverse events, respectively. The overall 12‐year drug survival rate for the unmatched population was 23.4%. In the propensity score–adjusted population, the hazard ratio (HR) for treatment discontinuation was significantly greater for adalimumab and infliximab versus etanercept (HR 2.89 [95% confidence interval (95% CI) 2.2–3.78] and HR 2.56 [95% CI 1.92–3.4], respectively), and no difference was found between and for adalimumab versus infliximab (HR 1.16 [95% CI 0.91–1.47]). The incidence of withdrawal due to secondary inefficacy was stable from 3 to 12 years for etanercept, but progressively increased for the monoclonal antibodies. Concomitant MTX significantly increased the survival of both adalimumab and etanercept (HR 1.48 [95% CI 1.18–1.86]). The overall 12‐year drug survival rate was 23.4%, being significantly higher for etanercept than adalimumab and infliximab. Etanercept discontinuations for inefficacy did not increase from 3 to 12 years. Concomitant MTX increased adalimumab and etanercept drug survival.

Objective.To test the learning curve of rheumatologists with different experience in videocapillaroscopy (VCP) attending an intensive training program focused on interpretation of the main capillary nailfold abnormalities, the scleroderma (systemic sclerosis, SSc) pattern, and the normal pattern, and to determine their interreader agreement with an experienced investigator.Methods.Five investigators (1 senior, 1 junior, and 3 beginners) participated in the exercise. The study was composed of 2 steps. First, an independent investigator selected representative VCP images of normal patterns and capillary abnormalities. The second step included the training program, which ran 4 hours per day for 7 days. The senior rheumatologist taught investigators to recognize and interpret the normal pattern, the capillary abnormalities, and the different types of SSc pattern. These abnormalities were considered: homogeneously enlarged capillaries, giant capillaries, irregularly enlarged capillaries, microhemorrhages, neoangiogenesis, avascular areas, and capillary density.Results.A total of 300 VCP images were read from all the investigators. Both κ values and overall agreement percentages of qualitative and quantitative assessments showed progressive improvement from poor to excellent from the beginning to the end of the exercise. The sensitivity and specificity of the participants in the assessment of SSc pattern at the last lecture session were high.Conclusion.Our pilot study suggests that after an intensive 1-week training program, novice investigators with little or no experience in VCP are able to interpret the main capillary abnormalities and SSc pattern and to achieve good interreader agreement rates.

Interferon- release assays (IGRAs) have been recently developed for the diagnosis of tuberculosis (TB) infection. The aim of the present study was to evaluate the performance of an enzyme-linked immunosorbent assay (ELISA)-based IGRA for detecting TB in children.

Mother-child human leukocyte antigen (HLA) diversity is protective for vertical transmission of some viruses. The aim of this study is to evaluate the role of mother-child HLA diversity on hepatitis C virus (HCV) vertical transmission. Forty consecutive HCV infected and 46 consecutive control uninfected children born to HCV-RNA positive mothers were evaluated for HLA class-1 type concordance with their mothers. No significant difference in the degree of HLA concordance was found between HCV infected and uninfected children both when A, B, C (p=0.30) and when only A and B alleles were evaluated (p=0.59). Mother-infant HLA concordance does not affect HCV vertical transmission.

Sphingosine (Sph) has been implicated as a modulator of membrane signal transduction systems and as a regulatory element of cardiac and skeletal muscle physiology, but little information is presently available on its precise mechanism of action. Recent studies have shown that sphingosine 1-phosphate (S1P), generated by the action of sphingosine kinase (SphK) on Sph, also possesses biological activity, acting as an intracellular messenger, as well as an extracellular ligand for specific membrane receptors. At present, however, it is not clear whether the biological effects elicited by Sph are attributable to its conversion into S1P. In the present study, we show that Sph significantly stimulated phospholipase D (PLD) activity in mouse C2C12 myoblasts via a previously unrecognized mechanism that requires the conversion of Sph into S1P and its subsequent action as extracellular ligand. Indeed, Sph-induced activation of PLD was inhibited by N,N-dimethyl-D-erythro-sphingosine (DMS), at concentrations capable of specifically inhibiting SphK. Moreover, the crucial role of SphK-derived S1P in the activation of PLD by Sph was confirmed by the observed potentiated effect of Sph in myoblasts where SphK1 was overexpressed, and the attenuated response in cells transfected with the dominant negative form of SphK1. Notably, the measurement of S1P formation in vivo by employing labelled ATP revealed that cell-associated SphK activity in the extracellular compartment largely contributed to the transformation of Sph into S1P, with the amount of SphK released into the medium being negligible. It will be important to establish whether the mechanism of action identified in the present study is implicated in the multiple biological effects elicited by Sph in muscle cells.

Sphingomyelinase (SMase) and ceramidase (CDase) activities participate in sphingomyelin (SM) metabolism and have a role in the signal transduction of a variety of ligands. In this study evidence is presented that caveolin‐enriched light membranes (CELMs) of murine endothelial cells, characterized by high SM, ceramide (Cer) and cholesterol content, bear acid and neutral SMase as well as neutral CDase activities. Localization of neutral CDase in CELMs was confirmed by Western analysis. Notably, cell treatment with cyclodextrin, which depleted cell cholesterol, did not affect acid or neutral SMase activities but significantly enhanced neutral CDase activity in CELMs, indicating a negative role for cholesterol in CDase regulation. These findings suggest that neutral CDase is implicated, together with SMase activities, in the control of caveolar Cer content that may be critical for caveola dynamics.

Sphingomyelinase (SMase) and ceramidase (CDase) activities participate in sphingomyelin (SM) metabolism and have a role in the signal transduction of a variety of ligands. In this study evidence is presented that caveolin-enriched light membranes (CELMs) of murine endothelial cells, characterized by high SM, ceramide (Cer) and cholesterol content, bear acid and neutral SMase as well as neutral CDase activities. Localization of neutral CDase in CELMs was confirmed by Western analysis. Notably, cell treatment with cyclodextrin, which depleted cell cholesterol, did not affect acid or neutral SMase activities but significantly enhanced neutral CDase activity in CELMs, indicating a negative role for cholesterol in CDase regulation. These findings suggest that neutral CDase is implicated, together with SMase activities, in the control of caveolar Cer content that may be critical for caveola dynamics.

It is generally thought that future advances in the treatment and cure of breast cancer patients will be made possible through a deeper understanding of tumor biology and an improved capability to define the prognosis of each single patient. This will lead to the formulation of new, more selective, and patient-tailored therapies. It is therefore important, when studying potential prognostic factors, to follow methodologic requirements and guidelines which involve the carrying out of prospective studies as confirmatory steps. Repeatedly or recently investigated prognostic markers (tumor size, menopausal status, ER, PgR, 3H thymidine labeling index, c-erbB-2 and p27 expression) were evaluated on a series of 286 prospectively recruited node negative breast cancer patients who underwent loco-regional treatment alone and were closely followed. The individual and relative prognostic contribution of each variable with respect to other factors, as well as their ability to identify node negative patients at risk, were assessed by univariate and multivariate analysis. At a five-year follow-up, only tumor size (p= 0.021) and TLI (p= 0.016) individually proved to be significant prognostic indicators of relapse-free survival. Conversely, p27 expression was not related to RFS and c-erbB-2 expression appeared to have only a short-term effect on patient prognosis. TLI and tumor size, tested in multivariate analysis along with ER and menopausal status, maintained their independent prognostic relevance. The study, performed on a large series of node-negative patients given loco-regional treatment alone, for the first time prospectively recruited, showed the prognostic relevance of TLI and its independence from other clinico-pathologic and biologic factors over a five-year period.

Microvessel density (MVD) of breast cancer is widely regarded as a prognostic factor, but results from studies on the most important case series have produced conflicting results. The present study was performed with confirmatory intent to define the prognostic relevance of MVD on a series of 378 node-negative-breast-cancer patients, much larger than any other series previously analyzed. Microvessels were stained using Factor-VIII antibody and an immunoperoxidase reaction. MVD was determined independently by 2 observers according to Weidner's methods. In parallel, cell proliferation was evaluated as S-phase fraction and determined according to the 3H-thymidine-labeling index method (TLI). Estrogen and progesterone receptors were quantitatively assessed using the dextran-charcoal technique. Tumor MVD varied greatly from tumor to tumor (2 to 232 MV/mm²) and was unrelated to patient age and menopausal status, or to tumor size, histology and steroid-receptor status. A significant (p = 0.004) but weak inverse correlation (rs = −0.188) was observed with cell proliferation. Univariate analysis using 40 MV/mm² as cut-off showed an inverse relation with 5-year relapse-free survival (82% vs. 71%, p = 0.018). This finding was limited to very small tumors, slowly proliferating tumors and ER-negative tumors. Multivariate analysis identified tumor size and TLI, but not MVD, menopausal status or ER as independent prognostic factors. Int. J. Cancer (Pred. Oncol.) 89:74–80, 2000. © 2000 Wiley-Liss, Inc.

Les tumeurs stromales gastro-intestinales (GIST) peuvent être situées n’importe où dans le tractus gastrointestinal. Les symptômes révélateurs sont consécutifs à ces complications : obstruction, hémorragie, perforation. Les GIST doivent être considérées comme à potentiel de malignité. La résection chirurgicale complète (R0) est le seul traitement potentiellement curatif. Nous présentons le cas d’une péritonite généralisée par GIST perforé du grêle, dans l’anse bilio-pancréatique du bypass gastrique. Gastrointestinal stromal tumors (GIST) can be located anywhere in the gastrointestinal tract. The revealing symptoms are resulting from complications: obstruction, bleeding perforation. All GIST should be considered to have a malignant potential. Complete surgical resection (R0) is the only potentially curative treatment. We present the case of generalized peritonitis due to a perforated GIST located in the bilio-pancreatic limb of a gastric bypass.

An easy venous access improves the quality of life of patients who need prolonged intravenous therapy. In the case of vena cava superior syndrome the classic access in the jugular or subclavian vein can be difficult or even impossible. We report on seven implantations of Port-a-Cath in the inferior vena cava for patients presenting contra-indications to classic venous access to the vena cava superior (five cases of vena cava superior compression syndrome, one tracheostomy and one extended tumor of thoracic wall). We describe the operative technique and we analyze the indications, the results and the complications of this rarely used technique. Ein einfacher venöser Zugang beeinflusst die Lebensqualität der Patienten, die eine langfristige parenterale Therapie benötigen. Bei Kompression der V. cava superior wird der übliche Zugang über die V. subclavia oder jugularis schwierig, unmöglich oder ist gar kontraindiziert. Wir berichten über 7 Patienten, bei denen wir einen Katheter in die V. cava inferior über die V. saphena eingelegt haben. Alle zeigten eine Kontraindikation für die Implantation eines Port-à-Cath®als klassischen V.-cava-superior-Zugang (5mal V.-cava-superior-Kompressionssyndrom, einmal Tracheostomie, einmal ausgedehnter Thoraxwandtumor). Wir beschreiben die Operationstechnik und untersuchen die Indikationen, die Resultate und die Komplikationen dieser selten angewandten Technik.

In order to evaluate the process of cell differentiation in the crypt of the rat small intestine the goblet cells were quantitatively studied in controls and after irradiation of the abdomen. The effect of a single dose, administered at 4 different times of the day, and multiple daily fractionations (MDF) of 6 and 12 Gy with different doses per fraction and different time intervals, were compared. Both regimens caused an initial increase of the goblet cells (both in absolute and relative terms), followed by a decrease and finally return to nearly control levels. After MDF the increase was more marked and the return to a normal level occurred earlier than after the single dose.