Based on results of trials emerged during the last 2 years and on data presented at the 8th International Conference on Primary Therapy of Early Breast Cancer held in 2003 in St. Gallen, a summary of current knowledge and controversies in the management of breast cancer is given. The following topics are covered: screening, biology, surgery, radiation therapy, primary systemic therapy, and adjuvant therapy (biological therapies, chemotherapy, endocrine therapies including ovarian ablation, and their interactions).

Rehabilitation and outpatient physiotherapy were investigated from the perspectives of patients suffering from rheumatoid arthritis (RA) or ankylosing spondylitis (AS) and of rheumatologists. In 2007, 204 outpatients with RA and 47 with AS at the Arthritis Center in Halle, Germany, and 117 rheumatologists from all over the country participated in two questionnaire surveys. Patients and rheumatologists gave predominantly positive judgements of physiotherapy, psychological interventions, and patient education programs. However, outpatient care including these interventions was judged to be mainly limited by fixed budgets and other formal restrictions. Even though these therapeutic options are part of (primarily inpatient) rehabilitation programs, the estimate of the need for multidisciplinary rehabilitation programs varied widely among the rheumatologists. Significant objections against rehabilitation include reluctance of the patients, administrative burden for the physicians, payers' rejections, and limited choice of rehabilitation clinic. Despite major functional limitations, a substantial portion of the patients received no multidisciplinary medical rehabilitation, outpatient physiotherapy, psychological interventions, or patient education. Recommendations for the improvement of care are derived from these data.

Flow E x a m i n a t i o n of 1%edon-Suction DrainageSummary. Mathematical and experimental results demonstrate that the customary Redon drain develops suction only over a very short initial distance. The disadvantage of rapidly diminishing suction is overcome in a newly developed drain in which equidistant openings of continually increasing aperture are aligned towards the drain end.

Methadone is an opioid that often leads to fatalities. Interpretation of toxicological findings can be challenging if no further information about the case history is available. The aims of this study were (1) to determine whether brain/blood ratios can assist in the interpretation of methadone findings in fatalities; (2) to examine whether polymorphisms in the gene encoding the P-glycoprotein (also known as multidrug resistance protein 1 (MDR1) or ATP-binding cassette sub-family B member 1 (ABCB1)), which functions as a multispecific efflux pump in the blood–brain barrier, affect brain/blood ratios of methadone. Femoral venous blood and brain tissue (medulla oblongata and cerebellum) from 107 methadone-related deaths were analysed for methadone by gas chromatography-mass spectrometry. In addition, all the samples were genotyped for three common ABCB1 single nucleotide polymorphisms (SNPs rs1045642, rs1128503, and rs2032582) using ion-pair reversed-phase high-performance liquid chromatography-electrospray ionization mass spectrometry (ICEMS). In nearly all cases, methadone concentrations were higher in the brain than in the blood. Inter-individual brain/blood ratios varied (0.6–11.6); the mean ratio was 2.85 (standard deviation 1.83, median 2.35). Moreover, significant differences in mean brain/blood ratios were detected among the synonymous genotypes of rs1045642 in ABCB1 (p = 0.001). Cases with the T/T genotype had significantly higher brain/blood ratios than cases with the other genotypes (T/T vs. T/C difference (d) = 1.54, 95% CI [1.14, 2.05], p = 0.002; T/T vs. C/C d = 1.60, 95% CI [1.13, 2.29], p = 0.004). Our results suggest that the rs1045642 polymorphisms in ABCB1 may affect methadone concentrations in the brain and its site of action and may be an additional factor influencing methadone toxicity.

ZusammenfassungGegenstand und Ziel: Überprüfung des Selenstatus von Pferden anhand der Konzentration von Selen (Se) im Serum und der Glutathionperoxidaseaktivität im Vollblut (GPx) zur Ableitung von Referenzbereichen. Material und Methoden: Warmblutpferde aus zwei Betrieben wurden bis zu viermal im Abstand von mindestens 3 Monaten beprobt. Für einen Rassenvergleich fand in drei Betrieben einmalig eine Blutprobenentnahme bei Vollblutpferden, Islandpferden bzw. Kaltblütern statt. Daraus resultierten insgesamt 1167 Blutproben von 528 klinisch gesunden Pferden. Die-Se-Konzentration wurde massenspektrometrisch analysiert, die GPx-Aktivität in heparinisiertem Vollblut photometrisch gemessen und auf den Hämatokrit bezogen. Das Referenzintervall umfasst die zentralen 95% der Werte aller gesammelten Proben adulter (Alter > 1 Jahr) Warmblüter. Ergebnisse: Die Se-Konzentration im Serum betrug 96 ± 38 µg/l, die GPx-Aktivität im Vollblut 94 ± 40 U/ml Hkt (Mittelwert ± Standardabweichung; n = 1167). Bei 48% der Pferde ergaben sich Se-Werte unterhalb des aktuellen Referenzbereichs von 100–200 µg/l. Alter, Rasse, Standort, Fütterung und Jahreszeit hatten einen Einfluss auf den Se-Status der Pferde. Die Korrelation zwischen der GPx-Aktivität und der Se-Konzentration ließ sich mit der linearen Regressionsgleichung y = 0,73 x + 23,76 beschreiben (y = GPx-Aktivität, x = Se) und es bestand eine signifikante positive Korrelation von r = 0,7. Der aus allen Proben (n = 909) adulter Warmblutpferde berechnete Bereich zwischen 2,5%- und 97,5%-Perzentil betrug für die Se-Konzentrationen 34–167 µg/l und für die GPx-Aktivität 34–175 U/ml Hkt. Schlussfolgerung und klinische Relevanz: Aufgrund der hohen prozentualen Anteils gesunder Pferde, deren Se-Werte nicht im Referenzbereich lagen, scheint der bisher geltende Referenzbereich von 100–200 µg/l zu hoch angesetzt zu sein. Anhand der erhobenen Werte wird für die Se-Konzentration im Serum ein Referenzbereich von 70–170 µg/l vorgeschlagen. Als ergänzender Parameter lässt sich die GPx-Aktivität im Vollblut nutzen, für die ein Referenzbereich von 50–175 U/ml Hkt empfohlen wird.