Praxis
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Aromatase inhibition is now an acknowledged second line treatment modality for advanced breast cancer in postmenopausal women. Aminoglutethimide is an inhibitor of adrenal steroid biosynthesis and blocks the conversion of cholesterol to pregnenolone, and therefore reduces levels of adrenal androgens, which are a source of estrogens in both premenopausal and postmenopausal women. Aminoglutethimide has produced antitumor response rates of 35% in unselected patients, most of whom have undergone prior therapy with either chemotherapy or hormonal manipulation. ⋯ New, less toxic compounds appear, which block the conversion of androstenedione to estrone and efficiently suppress plasma estrogen levels., e.g. formestane, anastrozole and letrozole. Aromatase inhibitors are now being compared to tamoxifen as first-line endocrine treatment in relapsing patients. If these trials confirm a similar or better response rate to new aromatase inhibitors compared to tamoxifen, the time will come to study them as the first line adjuvant treatment in non-metastatic disease.
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In a 67 year old patient with multiple cardiovascular risk factors a livedo reticularis, ischemic acral lesions as well as deterioration of renal function five weeks after cardiac catheterism and aorto-coronary bypass surgery led to suspicion of cholesterol embolism. Fundoscopy revealed cholesterol crystals in retinal vascular branches thus delivering important diagnostic information. ⋯ The lesions of the toes regressed and renal failure did not progress to dialysis. The diagnostic steps taken, the clinical picture of cholesterol embolism, the use of imaging and therapeutic options are discussed.
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Carcinoma of the thyroid is a rare tumour, comprising approximately 1% of human malignancies. Thyroid carcinoma is classified according to its origin (thyroid follicular cell or calcitonin-producing C cell) and grade of differentiation (differentiated, poorly differentiated or anaplastic). Due to their different biology, genetical background and clinical course, which result in fundamentally different therapeutic strategies, the various types of thyroid carcinoma have attracted a lot of interest by both clinicians and pathologists. This review article deals with the most important aspects (definition, epidemiology, clinical course, prognosis, differential diagnosis and genetic background) of the various thyroid carcinomas.
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Malignant pleural mesothelioma (MPM) remains a disease of very poor prognosis despite all new therapeutic approaches. We describe here 13 cases with MPM. The main symptoms at presentation were dyspnea (12/13) followed by weight loss (7/13), cough (3/13) and thoracic pain (2/13). ⋯ The mean survival after diagnosis was 6.8 +/- 5.0 months (range 1-16). At the present time, we believe that thoracoscopy is well indicated in any suspicion of MPM not only for diagnosis but also for palliative treatment of this pleural disease. However, there is a need for well controlled studies to improve the outcome of MPM.