There seems to be a therapeutic benefit for short-term endoscopic treatment but medium-term and long-term outcome remains questionable. Endoscopic stenting should be applied as an initial therapy before surgery, but it can be the definitive approach for older and morbid patients or cases with complete stricture regression after stent removal. Overall, it should not be considered as a routine procedure for symptomatic cases.

Endoscopic sphincterotomy of the pancreatic duct in patients with chronic pancreatitis is a fairly safe procedure with a high technical success rate.

The aim of the study was to assess the value of routine bone scintigrams, independent of the primary tumor stage or the presence of symptoms, in the postsurgical follow-up of breast cancer patients for the early detection of bone metastases. For this purpose 1,000 patients with postsurgical breast cancer without previous documentation of metastatic disease, who were admitted to the special oncology hospital, Onkologische Klinik Bad Trissl, entered a prospective study in 1987-1988. The parameters followed were the TNM stage of the primary tumor, the presence of pain, bone pain as revealed by a thorough physical examination, and the patient's history for the assessment of risk factors. In addition, a whole-body skeletal scintigram, supplementary X-rays, and additional diagnostic measures were performed, if necessary, to detect bone metastases. It was shown that in 856 of 894 patients (groups 1-6) without clinical symptoms, the clinical examination and radiological and scintigraphic diagnostic measurements, demonstrating the absence of bone metastases, gave matching results, but in 12 of the 894 patients the results of all examinations remained questionable. In another 12 of the 894 patients (groups 1-3) radiological and/or scintigraphical evidence for the presence of bone metastases was found. In 14 of 79 cases (groups 7-10) with clinically suspicious symptoms these were proven to be signs of metastases by subsequent scintigrams, supplementary X-rays, and additional diagnostic measures. In 65 of the 79 patients with clinically suspicious symptoms, bone metastases could not be confirmed by obtaining bone scintigrams or X-rays while in the other 14 patients (groups 9 and 10) evidence for the presence of bone metastases was found in the scintigrams and/or X-rays. However, 10 of these 14 patients were high-risk patients for developing bone metastases as they had axillary lymph node infiltration. The other 4 patients were of the low-risk group as they had positive receptor status or no axillary lymph node infiltration at the time of primary diagnosis. In 13 of 27 patients (groups 11-14) with clinical symptoms indicating the presence of bone metastases this diagnosis was confirmed by scintigrams and/or X-rays (groups 11 and 12), while it was possible to exclude the presence of bone metastases in spite of the symptoms in 11 of the 27 patients. In the other 3 patients the results of the additional examinations remained questionable.(ABSTRACT TRUNCATED AT 400 WORDS)

From 1977 to 1986, inclusively, 2511 patients with breast cancer were analysed. The following factors were evaluated: patients attitude toward screening programs, the method of cancer detection, the relation between tumor-size and axillary nodes metastases and efficiency of the currently in Germany used screening program. 65.9% of the patients underwent regular annual preventive physical examination, 15.2% irregular and 18.9% no examination. Only 12.7% of cancers were detected through the screening program, in 85% the patients discovered their tumors. Cancers up to 0.5 cm had in 25% lymph-nodes metastases and tumors up to 1.0 cm had in 27% of cases axillary nodes metastases. Breast cancers between 1.1 cm and 2.0 cm had a bad prognosis: the axillary metastases occurred in 34%-45%. Surprisingly, there were no differences in tumor size, percentage of residual tumor and frequency of axillary lymph-nodes metastases between patients who took regularly part in preventive physical examination and those never taking part. Women who irregularly participated in the program had the most unfavourable prognosis.

The pretherapeutically and histologically measured size of the tumor was compared in 2511 cases of breast carcinomas. Breast tumors up to 2 cm in size revealed a correspondence in the histologically and clinically measured tumor size in only 13.6%. 240 breast cancer patients having undergone a mastectomy with dissection of the axilla in 1986, were examined as to the number of histologically detected lymph nodes. In most cases nine lymph nodes were removed, this corresponds to 11.7%. An optimal surgical treatment and pathological diagnosis was found in 43.3% of all breast carcinomas with the required amount of 10 nodes, and in 28.3% with 12 lymph nodes. In order to emphasize the prognostic adequacy of the pTNM-classification, it is recommended to note down in brackets after the abbreviation pN0 the number of lymph nodes detected and to indicate for pN1 the relation between axillary nodes afflicted compared to the nodes examined.