Acta medica Austriaca. Supplement最新文献

The cure of a tumor patient with gastrointestinal cancer is dependent on the extension of the primary tumor (TNM-classification) and the option of curative resection (R0-resection) at the time of operation. The additional application of multimodal therapy approaches has lead to an improvement of prognosis in different advanced tumor stages. Nevertheless, despite curative tumor resection about 50% of patients with locally advanced gastrointestinal cancer develop recurrent tumor disease or distant metastases and die tumor-related. A possible explanation is the seed of disseminated tumor cells in blood, bone marrow or lymph nodes pre-, intra- or postoperatively, but also during diagnostic procedures. Several studies have shown in the last years that the presence of minimal residual disease (MRD) influences the course of disease and the patient's prognosis after curative tumor resection. Although several groups have reported the prognostic impact of disseminated tumor cells in the different compartments of bone marrow, lymph nodes and blood, the phenomenon of minimal residual disease is not acknowledged as an established prognostic factor and is not integrated into the classification of the UICC. Therefore, no therapeutic consequences were drawn at present from the detection of disseminated tumor cells in patients with gastrointestinal cancer. A possible explanation are missing multi-center-studies, which confirm the results of the several single-center-studies. Standardization of study designs and methodical procedures and the evidence of reproduction are mandatory in order to value and interpret the multitude of studies and the available data in this field. Only these results will allow to decide if the presence and detection of disseminated tumor cells can alter the tumor staging and individualize or possibly minimize further oncological therapy strategies.

The mean value of serum total cholesterol was 208 +/- 42 mg/dl for the study population. Sixty-five percent of investigated subjects had elevated cholesterol levels > 200 mg/dl. The percentage of subjects with low to moderate elevated cholesterol levels between 200-250 mg/dl was 40%, and 2% had a cholesterol higher than 300 mg/dl. Grouping the cholesterol levels by age and sex resulted in a high percentage of subjects with serum cholesterol > 200 mg/dl for the cardiovascular high-risk age group of 45-65 years old men and 55-75 years old women. Remarkably high was this percentage for women in this age-group; 71% had a cholesterol level > 200 mg/dl. In 59% of investigated women and 52% of men cholesterol should be lowered.

In 19,219 individuals (45.4% male, 54.6% female) with an age range from 10 to 95 years average body weight, body mass index (BMI), serum cholesterol and arterial blood pressure showed typical age-dependent changes. In the middle-aged between 45 and 65 years the high percentage of total cholesterol levels over 200 mg/dl (male: 58.3%; female 70.7%) seems alarming. In very old persons over 80 years the predictive value of those cardiovascular risk factors for increased mortality might be reversed, since in several epidemiological observations higher total cholesterol values and a high systolic blood pressure were associated with a longer survival. Average random blood glucose concentration is steadily rising with age. In good comparison with results from US American and European studies the age-matched relative risk for known myocardial infarction and stroke is twice to four times higher in individuals with known diabetes mellitus than in those without. These findings underline the urgent need for broadly based screening programs looking for metabolic and cardiovascular risk factors and for early disturbances of carbohydrate metabolism particularly in middle-aged groups, and for manifest diabetes mellitus in persons over 65 years of age.

Early and clinically occult hematogenous dissemination of tumour cells is considered a sign of systemic tumour progression, since recent data suggest that these cells are seminal precursors of subsequent distant metastasis. Single isolated tumour cells can be detected by means of immunocytochemical and molecular techniques at frequencies as low as 10(-5) to 10(-6) exploring different body compartments, such as bone marrow, peripheral blood and lymph nodes. This review summarises the currently available data on techniques that can be used to detect metastatic breast cancer cells in bone marrow and values their opportunities and limitations.

Early and clinically non-apparent hematogenous dissemination of tumor cells is considered an important prognostic factor and marker of tumor progression. This phenomenon is reported for tumor entities differing as much as breast and gastrointestinal cancers. First prospective studies point to the unique opportunity of therapy monitoring utilizing follow-up bone marrow aspirations before and after adjuvant therapy. First results of these studies further indicate that currently used treatment strategies such as chemotherapy may not be efficient enough to eliminate all metastatic cells in all of the cases studied. Apart from improved tumor staging, such screening efforts may not only help to improve planning and monitoring of adjuvant therapy (which at present is only possible retrospectively) but also help to design individualized targeted biological treatment. This review summarizes the currently available data on the importance of disseminated tumor cells for the treatment of patients with breast or gastrointestinal cancer.

Four risk-categories for diabetes probability where defined by measured random-blood glucose values: minimum risk (random blood glucose < or = 95 mg/dl), low (96-139 mg/dl), moderate (140-199 mg/dl), and high (> or = 200 mg/dl). Using these risk categories and other risk factors as age, sex, BMI, and cholesterol, further data analysis were made. Among high-risk patients, male sex was represented two fold compared to female sex. In +65 year old subjects the diabetes risk increased from 8.2% for the whole study cohort up to 12.1%. An increase of body weight was paralleled by an increased risk for diabetes, whereas in the highest diabetes risk-group, obese subjects (BMI subgroup 4) were twice as frequent as in the next lower risk category. Additionally, 62% of subjects with a high diabetes risk had elevated cholesterol levels.