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Detection of disseminated tumor cells (DTCs) in bone marrow is an independent prognostic factor in primary breast cancer. Here, we conducted a proof-of-principle study to evaluate whether this tumor cell spread occurs already in patients with ductal carcinoma in situ (DCIS). After preoperative screening by stereotactic core biopsy, 30 consecutive women with DCIS were included. Bone marrow aspirates, taken at the time of primary surgery, were subjected to DTC detection by a standardized immunoassay using the established monoclonal anti-cytokeratin antibodies A45-B/B3 and AE1/AE3. DTCs were detected in 4 of 19 cases of pure DCIS (21.1%) and in four of seven cases of DCIS with microinvasion (57.1%). After a median follow-up time of 22 months, two initially DTC-positive patients suffered from contralateral carcinoma and contralateral DCIS at months 12 and 30, respectively, whereas the remaining patients were relapse free. Thus, hematogenous tumor cell dissemination into bone marrow is an early event in breast cancer development.Breast cancer is the most common malignant disease in women. According to a meta-analysis including 4,703 Stage I-III breast cancer patients, the detection of disseminated tumor cells (DTCs) in bone marrow is associated with poor prognosis.1,2 Interestingly, DTC detection is seen in small primary carcinomas and is not only a predictor for metastatic relapse in bone and other organs but also for local relapse, 2 supporting recent experimental data that breast tumor cells may recirculate from bone marrow back to the primary site where they might contribute to local relapse and even primary tumor growth.3 Thus, bone marrow might be a reservoir for breast tumor cells in which they may survive for an extended period of time. 4,5 Thus far, the time point of the onset of breast tumor cell spread is unclear. A DCIS is a nonobligate precursor of invasive breast cancer. However, 1-2% of all primary DCIS patients present positive axillary lymph node metastases. 6 Indeed, classification of DCIS is based on histopathological criteria and on the growth dimensions. 7,8 Remarkably, DCIS patients may relapse with invasive breast cancer, whereas patients with large, high-grade DCIS with necrosis are at higher risk of developing recurrence. Furthermore, DCIS patients with poorly differentiated histological types are associated with higher rates of distant metastases and death within a long follow-up period. 9 The rate of metastases increases after invasive local recurrence.10 Free surgical margins and postoperative radiotherapy are the most important and significant prognostic factors for local disease control, 11 but none of them can reliably predict the risk of invasive recurrence. 12,13 Material and MethodsOur proof-of-principle investigation focused on the search for DTC in bone marrow aspirates from 30 patients who were treated with the suspicion of DCIS at the Goethe-University hospital and the Diakonie Medical Center, Frankfurt, Germany. Written informed consent was provided by all patients, and the stud...

The specific disadvantage of the commonly used Vecchietti method for reconstruction of the vagina in cases of vaginal agenesis is the need for laparotomy. We now describe a successful endoscopically assisted construction of a neovagina by a variation of the Vecchietti method. The method causes relatively little stress to the patient.

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Fertility and adhesions were examined in 41 rabbits in three treatment groups following the construction of microsurgical anastomoses with fibrin glue and by conventional suturing techniques. The three types of treatment were: isthmic anastomoses without resection, ampullary anastomoses, isthmic anastomoses following resection of oviduct segments. There were no significant differences between the two methods of performing the anastomoses in any of the three groups with respect to number of ovulations, number of implantations, nidation index, and pregnancy rate. The extent of the formation of adhesions was also no different between the two types of anastomosis construction. From the functional point of view, fibrin glueing of the tubes can be considered as good as microsurgical suturing. Another study is planned to examine whether this is also true from the morphological viewpoint. It must be remarked that fibrin glueing does not appear to be suitable for anastomoses in which a lumen-adjusting technique is needed or for deep tubocornual or intramural anastomoses.

We studied the effect of fibrin sealant and peritoneal grafts applied by fibrin glue on adhesion formation in the rat. Sealing and patching of ischaemic lesions of the uterus resulted in a significant increase in adhesion formation. We conclude, that fibrin sealant and peritoneal grafts can not be given general approval for prophylaxis of intraperitoneal adhesions.

The specific disadvantage of the Vecchietti technique for construction of a vagina in cases of vaginal agenesis is the need for laparotomy. We describe an endoscopically assisted construction of a vagina by a variation of this method and report on the first five cases operated on without any complications and with good functional results.

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