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BRCA1 associated tumours are found to express an oestrogen receptor negative “basal epithelial-like” phenotype. In contrast to ER negative tumours in general, such tumours rarely harbour amplification of the HER-2 gene. However, little is known about TOP2A gene amplification status in BRCA1-associated tumours. Such information may be of importance to therapy, as amplification of TOP2A has been associated with dose-dependent sensitivity to anthracycline therapy in breast cancer. We examined 40 breast carcinomas from BRCA1 mutation carriers and 40 sporadic breast carcinomas matched for age, tumour diameter and histological grade for HER-2 and TOP2A amplification status using fluorescence in situ hybridisation (FISH). Co-amplification of TOP2A and HER-2 was found in four of the mutation carriers and in three of the controls. While six tumours in the control group harboured HER-2 amplifications with normal TOP2A, this occurred in three of the BRCA1 associated tumours only. In contrast, three of the BRCA1-associated tumours but none of the controls harboured TOP2A amplification despite normal HER-2 status. Our findings have potential therapeutic implications. HER-2 assessment is routinely used to select breast cancer patients for trastuzumab but also dose-intensive anthracycline therapy. Our data suggest that BRCA1-associated breast cancers also need to be tested for TOP2A amplification. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate subcutaneous transcapillary fluid balance during pulsatile and nonpulsatile extracorporeal circulation (ECC). Changes in the transcapillary fluid balance were studied by measuring subcutaneous interstitial fluid pressure (Pif) using the 'wick in needle' (WIN) method, as well as measuring subcutaneous interstitial fluid colloid osmotic pressure (COPif), using either the wick technique or the blister suction technique. The measurements were performed on the chest wall at the heart level. Simultaneous recordings of plasma colloid osmotic pressure (COPpl) were carried out. Nineteen male patients undergoing aortocoronary bypass grafting were subjected to nonpulsatile flow (group I, n = 11) or pulsatile flow (group II, n = 8) during ECC. Preoperatively there was no difference in the Starling forces between the two groups. During ECC the COP gradient (COPpl-COP if) was reversed to the same extent in the two groups. At three hours and six hours following ECC, COPif in the pulsatile group (12.1 mmHg and 11.4mmHg respectively) was significantly higher than in the nonpulsatile group (10.8mmHg and 10.3mmHg respectively). When weaning from ECC as well as three hours and six hours following ECC, Pif in the pulsatile group was significantly lower than in the nonpulsatile group. Conclusion: in the early postoperative period there is less dilution of the subcutaneous interstitial tissue following application of pulsatile flow during ECC compared to nonpulsatile flow. [ABSTRACT FROM PUBLISHER]

We have some problems getting younger doctors to specialize in vascular surgery. The reasons for this are not completely clear. Some of them feel that the number of open operations is decreasing and that more and more of the treatment is done by endovascular techniques. Although the surgeons are involved in this work in Norway there is an uncertainty about the future. Furthermore, a more systematic training in endovascular surgery seems necessary. This is a very important problem that we should discuss, and we suppose the problem is the same in many other European countries. Economical factors may also pay a role for the younger doctors when they plan their future. GP''s are in general earning a lot more than those who are employed at hospitals and there are very little differences in salary between junior doctors and senior colleagues who have been in the hospital for decades putting a lot of effort into clinical work, administration and teaching. [Copyright &y& Elsevier]