Summary The development of familial and sporadic breast cancer is based on genetic alterations of tumoursuppressor genes, for which loss of heterozygosity (LOH) is one mechanism of gene inactivation.

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Bei konservativ nicht beherrschbarer Uterusatonie werden verschiedene invasive Techniken zur Uteruserhaltung empfohlen. Die Methoden sind aber umstritten (Uterustamponade), nicht generell verfügbar (arterielle Embolisation), wenig bekannt oder technisch schwierig (Ligatur der Aa. uterinae bzw. iliacae internae). Wir berichten über erste Erfahrungen mit einer 1997 von B-Lynch et al. publizierten Nahttechnik. Methode: Bei 3 Patientinnen mit postpartaler Atonie wurde der Uterus durch eine fortlaufende, im Bereich der Vorder-und Hinterwand des unteren Uterinsegmentes verankerte und beidseits über den Fundus geführte ¹Hosenträgernahtª komprimiert. Ergebnisse: Alle Frauen waren transfusionspflichtig, eine hatte eine Koagulopathie. Die Naht war der letzte Versuch der Uteruserhaltung. Sie lieû sich technisch einfach binnen 5 bis 10 Minuten legen. Innerhalb von 15 Minuten kam es zur deutlichen Blutungsverminderung, so dass die Hysterektomie in allen Fällen unterbleiben konnte. Schlussfolgerung: Die wenigen bislang berichteten Fälle lassen die B-Lynch-Naht als einfache und effiziente operative Technik zur Beherrschung der Atonie erscheinen. Die Wirkungsweise dürfte auf der kontinuierlichen Uteruskompression in Verbindung mit einer Reduktion der Durchblutung uteriner und uteroovarieller Gefäûäste beruhen. Summary Objective: Various invasive techniques have been used to control postpartum bleeding in patients with uterine atony refractory to medical measures. Some methods are controversial (e.g., uterine tamponade), not widely available (e.g., arterial embolization), little known, or technically demanding (ligation of the uterine or internal arteries). We describe our experience with the suture technique described by B-Lynch in 1997. Methods: We used the B-Lynch technique in three patients with postpartum uterine atony in an attempt to avoid hysterectomy. All patients required red cell transfusions, one developed a coagulation disorder. The B-Lynch technique involves anchoring a running suture in the anterior and posterior aspects of the lower uterine segment and running the suture over the uterine fundus in a suspender-like fashion. This apparently keeps the uterus compressed, with subsequent reduction of uterine perfusion. Results: The B-Lynch suture required 5 to 10 minutes to perform. Bleeding declined markedly within 15 minutes and no patient required hysterectomy. Conclusion: The small number of cases reported to date suggest that the B-Lynch suture is a straightforward and efficient technique to control severe bleeding due to postpartum uterine atony.

An inhibition of peripheral conversion of T4 to T3 is thought to be of benefit in the treatment of thyrotoxicosis. Therefore, propylthiouracil (PTU) has been considered to be more effective in the therapy of hyperthyroidism than methimazole, since the former has the additional peripheral effect of decreasing the conversion of T4 to T3, From in vitro studies PTU is known, however, to inhibit the deiodination at the 5' as well as at the 5 position of the iodothyronine molecule. To study if PTU blocks degradation in T3 in vivo as well, the effect of PTU on thyroid hormone concentrations in serum and liver tissue during a constant and high administration of T4 or T3 to rats was followed. It was shown that PTU clearly inhibits T4 and reverse T3 degradation. Moreover, simultaneous treatment of the rats with T3 and PTU resulted in a significantly higher increase of T3 concentration in liver tissue (11.5 ng/g liver vs 5.6 ng/g liver) and serum (615 ng/di vs 345 ng/dl) than with T3 alone. This effect may be explained by an inhibition of the T3 degradation by PTU in vivo as well. Provided the results obtained from these animal experiments can be applied to the situation in man, the inhibition of peripheral deiodination could have an adverse effect at least in the treatment of T3-thyrotoxicosis.

Approximately one third of all local recurrences of breast cancer are incurable at the time of diagnosis. Locoregional intraarterial chemotherapy is one of the new therapy modalities besides laser therapy and combined radiotherapy/hyperthermia. The results of a phase I-II study, in which 15 patients with advanced, partly pretreated local recurrences as well as 2 patients with T4N2/N3 tumours were included, are reported as follows. All in all, 39 superselective intraarterial chemotherapy courses were carried out. Mitomycin (10 mg) and Mitoxantrone (25 mg) were infused over 90 min. The side effects due to the catheter system were two haematomas and one thrombosis attributed to an insufficient heparin dose. Locally, the chemotherapy was well tolerated. One severe systemic side effect, a leucopenia WHO 4 degrees was observed. Nausea, thrombocytopenia and alopecia rates were low (7 x nausea 1 degree, 5 x thrombocytopenia 1 degree, 2 x thrombocytopenia 2 degrees, 2 x alopecia 1 degree). 6 Complete remissions (3 x pCR, 3 x cCR) as well as 6 partial remissions and 5 no changes were found. We believe that this method, because of the low side-effect profile and the temporary good results, represents a good alternative in otherwise incurable locoregional recurrence of breast carcinoma and in specified cases of locally advanced disease. 1 degree and 2 x thrombocytopenia 2 degrees, 2 x alopecia 1 degree). Altogether, 6 complete remissions were found (3 x cCR, 3 x pCR), 6 partial remissions with 4 x no change occurred.(ABSTRACT TRUNCATED AT 250 WORDS)