[Medical care of adults with congenital heart diseases : Present and future]

Congenital heart diseases (CHD) are the most common types of congenital organ defects. Thanks to medical progress in congenital cardiology and heart surgery, most children with CHD reach adulthood. Despite primarily successful treatment residual and subsequent conditions as well as (non)cardiac comorbidities can influence the chronic course of the disease and lead to a higher morbidity and mortality. Adults with congenital heart disease (ACHD) in Germany are not tied to the healthcare structure despite the great need for aftercare. According to the results of the medical care of ACHD (MC-ACHD) study, ACHD centers and specialists in Germany are insufficiently perceived despite increased complication rates and the great need for specialist guidance. General practitioners and patients are not adequately informed about existing ACHD facilities. A better awareness of the ACHD problem should be created at the level of primary medical supply in order to optimize care and to reduce morbidity and mortality. Improved future-oriented patient care includes lifelong regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD.

Monoclonal 3C6F9 distribution in human breast carcinomas: image cytometry of immunocytochemical assays

MoAbF9 immunoreactivity was investigated in frozen sections of 123 breast carcinomas using an avidin or streptavidin biotin peroxidase kit. A standardized computer image analysis system was used to evaluate immunostaining. The percent of cell surface staining and mean optical densities were correlated with morphological criteria of prognosis such as tumor size histological grade, blood and lymph invasion and axillary lymph node involvement, with immunoreactivity to other MoAb, i.e. Ki67, anti-RE and anti-RP, anti-p.HER-2/neu and with tumor aneuploidy and AgNORs content in tumor cell nuclei. Despite some heterogeneity, MoAbF9 was reactive with all breast carcinomas tested. The percent of F9 immunostained cell surface and mean optical density increased with Ki67 immunoreactivity, tumor aneuploidy and AgNORs nucleus surface but were independent of p.HER-2/neu oncoprotein distribution and tumor receptor content. These findings suggest that F9 could not only allow detection axillary lymph node micrometastases but also be used as plasmatic marker for tumor recurrence and metastases.

Image cytometry of aneuploidy, growth fraction (MoAb Ki-67) and hormone receptors (ER, PR) immunocytochemical assays in breast carcinomas

DNA nuclear content was assessed in human breast carcinomas (n = 132) using image cytometry. Optical density histograms of Feulgen stained cell imprints from fresh tissue samples, subsequently frozen for immunocytochemical assays, were determined by the SAMBA system and used for the DNA index, the ploidy balance (PB) and the proliferation index (PI) computation. The three parameters were correlated to (i) histological data (tumour grade, vascular and/or lymph node invasion) and to (ii) growth fraction (Ki67), hormone receptor antigenic sites (ER, PR) and intramedullar (bone marrow) biopsies and anti-KL1-positive epithelial cells. It was shown that 57% of breast carcinomas were aneuploid. Aneuploidy PI significantly correlated to the criteria of poor prognosis such as high tumour grade, vascular and lymphatic invasion and to increased Ki67-positive cells, and the absence of or low ER and PR. Since image cytometry is easy to handle and perfectly suitable for current diagnostic practice in pathology departments, particularly for tumour cell ploidy assessment and standardized analysis of immunostaining procedures with morphological control of the preparation, we conclude that image cytometry, as performed with the SAMBA, must be regarded as a relevant tool for prognosis evaluation and therapy guidance in individual patients.

Bromocriptine effects on cultured human prolactin-producing pituitary adenomas: in vitro ultrastructural, morphometric, and immunoelectron microscopic studies

In an effort to better characterize the ultrastructural, morphometric, and immunocytochemical changes induced by 10(-8) M bromocriptine (BR), tumor cells from three surgically removed PRL-producing pituitary adenomas were cultured on an extracellular matrix in serum-free medium. In each instance, the treated cultures were compared to control cells at the end of 24 h and 16 days. PRL RIAs were performed on culture medium. A decrease in cell and nucleus surface area was found on day 16 in two cultures. This supports the well known shrinkage of BR-treated PRL-producing adenomas. BR induced no change in these parameters in the tumor from a third patient who was partly resistant to the drug. Changes in the secretory process were discernible as of day 1 in all three tumors, with a dramatic reduction of exocytosis and intracellular accumulation of PRL-immunoreactive granules. This induced delayed inhibition of protein synthesis, demonstrated by preembedding immunocytochemistry on day 16. These results, obtained for the first time in human PRL-producing adenomas, are informative as to the subcellular events subsequent to short term BR treatment and illustrate that secretory inhibition and tumor shrinkage are not necessarily linked.

Kappa casein, lactalbumin and GCDFP 70 localization in human breast carcinomas: an immunohistochemical study using the avidin-biotin-peroxidase complex method

A retrospective study of 67 human breast carcinomas of various types and grades was conducted using the avidin-biotin-peroxidase complex (ABC) to localize casein, lactalbumin, and GCDFP 70 on paraffin sections. Estrogen and progesteron receptors also were evaluated. This study demonstrated the following: (1) Casein positive cells were present in all cases with a variable distribution and degree of staining, whereas lactalbumin and GCDFP 70 were seen in only 40 and 43% of the cases, respectively. (2) No significant relationship was observed between casein, lactalbumin, GCDFP 70 and the histologic types of tumors or the extent of stromal elastosis, with the exception GCDFP 70, which was observed more often in well-differentiated ductal carcinomas. (3) No significance was established in the relationship between antigens and steroid receptor content, with the exception of casein; strong casein immunostaining was significantly related to high progestin receptor levels. (4) Lactalbumin and GCDFP 70 were significantly associated with each other, but independently so of the histologic grades and types, the extent of stromal elastosis, and the steroid receptor content of the tumor cells.

Localization of lactoferrin and nonspecific cross-reacting antigen in human breast carcinomas. An immunohistochemical study using the avidin-biotin-peroxidase complex method

A retrospective immunocytochemical study was performed on 67 human breast carcinomas to determine whether the epithelial cell-associated antigens, lactoferrin and nonspecific cross-reacting antigen (NCA), could be used as markers in the prognostic assessment of breast cancers. Fixed paraffin sections were tested with anti-lactoferrin and anti-NCA. Lactoferrin and NCA were found in 7.5% and 19% of the cases, respectively. Furthermore, the association between these two antigens in tumor cells was significant (P less than 0.05). Kappa-casein was observed in all antigen-positive cases. These antigens were observed more often in low-grade ductal carcinomas that had positive estrogen and progestin receptors, but no relationship could be established between lactoferrin or NCA and other prognostic indicators, such as histologic type and grade of the tumor, stromal elastosis, or steroid receptors. Although more antigen might have been detected in unfixed, frozen specimens, the results indicate that lactoferrin and NCA possess minimal value as epithelial cell markers and no prognostic value when detected on routinely fixed, paraffin-embedded samples.