Management of Lymphoedema is extremely variable in the medical profession, ranging from aggressive diagnostic procedures, which may aggravate the disease (lymphography by oily contrast mediums) in combination with therapeutic nihilism to precipitous operations. Scattered between these two contraversial extreme positions are quite a number of various conservative methods - some of which being in conflict with the anatomy and physiology of the lymph vascular system and the pathology of Lymphoedema. Lymphoedema, if left untreated, or is treated inadequately, may lead to invalidity and to death if Stewart-Treves Syndrome develops. Unnecessary surgery may have disastrous consequences. The paper describes how Lymphoedema can be treated with success, free of any side effects, by complex physiotherapy.
Abstract. Malignant tumors degrade glucose to lactate even in the presence of oxygen via the pentose phosphate pathway (ppp). The non-oxidative part of the ppp is controlled by thiamine-dependant transketolase enzyme reactions. Overexpression of the transketolase-like-1-gene (TKTL1) in urothelial and colorectal cancer is associated with poor patient outcome. We analyzed the expression of the TKTL1 protein in a retrospective institution-based patient cohort with invasive breast cancer by immunohistochemical analysis of 124 paraffin-embedded breast cancer tissues. Our study revealed TKTL1 expression in 86% of breast cancer specimens with 45% showing high expression levels. In contrast, only 29% of corresponding non-neoplastic breast tissues were TKTL1 immunopositive, including 9% with high expression levels. High expression levels of TKTL1 correlated significantly to Her2/neu overexpression (p=0.015). However, TKTL1 expression failed to reach statistical significance for other common prognostic parameters. In contrast to recent data for e.g. colorectal cancer TKTL1 overexpression did not correlate to patient outcome and survival. However, in the context of novel insights into TKTL1-related tumor metabolism and the high proportion of TKTL1 overexpressing breast cancers, this enzyme represents a potential candidate for targeted inhibition of tumor growth in this tumor entity.
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