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IntroductionIn 1965 Jackson (Jackson et al. -1965) reported an unusually high incidence of Klinefelter's syndrome in man with breast cancer. That observation was confirmed by other reports. Including the case reported in the present paper 28 cases of breast cancer associated with Klinefelter's syndrome have been described. The frequency of breast cancer in this syndrome has been explained by chromosomal abnormalities like the presence of two X chromosomes as well as by gynecomastia. The present report describes hormonal alterations, which might be of influence in this disease. Case reportIn 1978 a 44 year old man was admitted to the department of internal medicine for evaluation of bilateral gynecomastia which has been known since 2 years. At the age of 18 the diagnosis of a hypogonadism with azoospermia was established. Since then a decrease of libido was noticed. He showed no eunuchoid habitus. The axillary and pubic hair were normal, but beard was scanty. The phallus was normally developed. The testes were small with a volume of 5 ml. The diagnosis of a Klinfelter's syndrome was suggested. The chromatin positive buccal smear and the XXY karyotype of the chromosomes confirmed the diagnosis. Plasma levels of LH, FSH and prolactin were measured by RIA-KID'S; standards of MRC 68/40 and 69/ 104 respectively were used for calibration. Plasma testosterone was assayed according the method of Nieschlag. The plasma concentrations were: LH = 45.0 mIU/ml, FSH = 18.0 mIU/ml, prolactin = 8.2 ng/ml and testosterone = 3.0 ng/ml. The values were interpreted as a hypergonadotropic hypogonadism with normal prolactin. The patient was subsequently treated with 250 mg testosterone-enanthate at four weeks intervals.In September 1980 the patient again was admitted to the hospital because of painful left breast with retracted mamilla, which showed secretion since 6 months. The mammography suggested an infiltrating carcinoma of the left breast and a gynecomastia Vera of the right. The histological examination revealed an infiltrating undifferentiated carcinoma of the mamms with a productive fibrosis. The determination of steroidhormone receptors in the tumor tissue was carried out by incubation with tritiated estradiol, progesterone (R 5020), dihydrotestosterone and dexamethasone and separation by agargel electrophoresis. 1 13 fmol of estradiol and 45 fmol progesterone were bound per mg cytoplasmatic protein. Both values are above the normal range. Androgenand corticosteroidreceptors could not be detected. andrologia 14 (1982) 318 R. Ries et al.For the evaluation of distant metastases a chest x-ray, an ultrasonogram of the abdomen and the bone scan were performed. No metastases could be detected. The axillary nodes were free. According to the staging classification the tumor had a TI NoMo status. All laboratory data except of the sedimention rate were in the normal range. The carcinoembryonic antigen (CEA) was not elevated. Postoperative radiation therapy was given for one month with a total tumor dose of 46 gy.During a testosterone in...

The aim of the rheumatology network ADAPTHERA ("risk-adapted rheumatology therapy") is to achieve a comprehensive improvement in rheumatology care by coordinating treatment in a regional, trans-sectoral network. Accompanying biomedical research projects, training concepts, and the construction of a rheumatology register (gathering data and biomaterials) should furthermore ensure the stable and sustainable optimisation of care. In the pilot phase (2012-2015) the focus of the ADAPTHERA network, required as a "regional key project" within the framework of the Initiative on Health Economy of Rheinland-Palatinate (RL-P), Germany, was placed on the optimisation of the early diagnosis of rheumatoid arthritis, where it is well-known that there is a significant care deficit.Through the intensive, stable, and coordinated cooperation of all health care partners in the field of rheumatology (registered general practitioners and orthopaedic specialists, registered core rheumatologists as well as the Association of Rheumatology of RL-P) a unique regional, comprehensive offer with verifiable care optimisation has been established in RL-P. The network is supported by outstanding collaboration with the Association of Statutory Health Insurance Physicians and the self-help organisation Rheumatology League.The aims that were established at the start of the project will be achieved by the end of the pilot phase:- significant improvement in the early diagnosis of rheumatoid arthritis (an average of 23.7 days until diagnosis by rheumatologists)- access covering all health insurance (regardless of the particular scheme the patients belong to)- comprehensive (verifiable participation of general practitioners from all over RL-P)- data and biomaterials collection, established as a basis for biomarker research, and a rheumatology register for RL-P.

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