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Maximum control of local disease in early breast cancer is obtained by breast conserving surgery, minimally invasive surgery of the axilla and consecutive selection for adjuvant therapy based on the number of involved axillary level I nodes. The answer to the question what is a 'node negative' patient? by defining the number of lymph nodes excised at operation exclusively, and the number of involved nodes found by the pathologist is given. Based on the data of Veronesi et al (Eur J Surg Oncol 16: 127-133, 1990) on 1446 complete axillary dissections performed between 1983-1986, the mathematical basis of the incomplete axillary dissection of the axilla in early breast cancer is presented: (i) To achieve a degree of confidence of 90% of the entire axilla being negative, histological examination of 10 level I nodes for a T1 tumor and 11 level I nodes for a T2 primary are necessary. In order to obtain these lymph nodes a total en bloc dissection of level I is indicated. (ii) The axillary status was considered negative if 10 or more lymph nodes for T1 or 11 or more in T2 tumors were found and were negative. (iii) The axillary status was considered positive, if <10 lymph nodes in T1 or <11 nodes in T2 tumors were found, even if they all were negative. If positive lymph nodes are left or estimated in the axilla after incomplete dissection, surgical treatment of the axilla is mandatory.

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The major prognostic indicator in patients with breast cancer is the presence of metastases in axillary lymph nodes. The authors developed a mathematical model, based on 1446 complete axillary dissections performed in Milan between 1983 and 1986, and determined the following: (1) the sample size from Level I necessary for a 90% certainty degree of N0 axillary status; (2) the probability of residual tumor in the axilla after axillary sampling from Level I; and (3) the maximum number of involved axillary nodes in Levels I, II, and III to be expected (90% certainty) after sampling from Level I. Thus, this model permitted the determination of the cutoff level for a true N0 axillary status when only a few nodes are sampled from Level I. The cutoff level for a T1 primary tumor is ten axillary nodes removed and found uninvolved. Also, this model provides guidance in managing possible residual tumor after an incomplete axillary dissection. This information is important in indicating adjuvant axillary radiation therapy and chemotherapy or hormone therapy.

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Mental hospital staff who are assaulted by patients are at risk of developing symptoms associated with posttraumatic stress disorder. The Assaulted Staff Action Program (ASAP), a voluntary program, offers support to staff victims of patient assaults in a state mental hospital. ASAP team members debrief assault victims, assessing the victim's sense of control, social supports, and ability to make sense of the incident. A short-term support group is offered. During the program's first 90 days, the team responded to 67 assaults. Ten days after the assaults, many of the victims had not regained a sense of control, did not have a support network, and were unable to make sense of the incident. These factors put them at risk for PTSD symptoms. The costs of such a program are discussed.

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Conception, structure and realisation of a new data base for radiation therapy are presented. The data base utilizes the commercial data base system ORACLE and the data base language SQL. A program package for statistical analyses including Kaplan-Meier-calculations, logrank test and Gehan/Breslow test was elaborated. The input of the data recorded on form sheets is carried out on a data base of the Tumor Centre in the first instance. From there the data are transferred to the ORACLE data base. Up to now the courses of disease of about 13,000 patients are stored. Therefore, extensive and detailed statistical analyses are practicable.

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Primary non-Hodgkin's lymphoma occurs quite seldom in the nasopharynx, therefore reports on this topic are rare in medical literature. The treatment results of 30 irradiated patients (40 to 60 Gy) are presented. The period of the study ranges from 1960 to 1985. 13 patients with low grade lymphoma and 17 patients with high grade lymphoma according to the Kiel classification form the basis of this study. The overall actuarial 5-year survival rate is 24%. This also applies for the subgroups of low grade and high grade lymphomas with a 5-year survival rate of 24%, respectively. The evaluation of the patients without generalization in the course of disease shows that the prognosis of stage IE patients with 43% was superior to the one of stage IIE patients with 25% (p less than 0.001). Only patients with lymphoma limited to the nasopharynx survived longer than five years (46%), but none of the patients with simultaneous spread to the nasal cavity, the oropharynx and/or the base of the skull. Local and regional recurrences were rare. However, a generalization of the disease occurred more often (20%), mainly due to insufficient staging in former years. Long-term sequelae of the radiation therapy like rhinitis or pharyngitis sicca were registered occasionally. At present, locoregional radiation therapy is recommended for stage IE and IIE low grade lymphomas and stage IE high grade lymphomas of the nasopharynx.

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We describe the technique and illustrate results of renal calculi analyses utilizing correlative analytical scanning electron microscopy and x-ray microdiffractometry on the same 100 micrometer Spurr embedded sections. Essential to the technique is the employment of an extremely sensitive x-ray microdiffractometer, and for morphological analysis, pretreatment of the sections with a sodium ethoxide etching solution. This technique facilitates more precise identification of crystalline constituents especially calcium apatite and magnesium ammonium phosphate hexahydrate (struvite). Further, the technique permits detection and mapping of both crystalline and amorphous constituents within calculi.

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