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1.  The Oncological Emergency Case: Paraneoplastic Hypoglycemia in Metastatic Breast Cancer – Case Report and Brief Review of the Literature 
Breast Care  2013;8(5):368-370.
Summary
Background
Paraneoplastic hypoglycemia is a rare syndrome amoung tumorous diseases. It is often associated with a paraneoplastic secretion of ‘big’ insulin-like growth factor-II.
Methods
We describe this syndrome in a 60-year-old patient with advanced breast cancer 8 years after primary diagnosis.
Results and Conclusion
This non-islet cell tumor-induced hypoglycemia may be the only evidence for an otherwise clinically occult disease progression. Fast diagnosis and appropriate acute and causal treatment concepts should be part of oncological management.
doi:10.1159/000355702
PMCID: PMC3861876  PMID: 24415991
Hypoglycemia; Breast cancer; Metastases; Insulin-like growth factor; Paraneoplastic
2.  Filariasis of the Axilla in a Patient Returning from Travel Abroad: A Case Report 
Breast Care  2012;7(6):487-489.
Summary
Background
The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites.
Patients and Methods
A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy.
Results
On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae.
Conclusion
Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine.
doi:10.1159/000345471
PMCID: PMC3971795  PMID: 24715832
Filariasis; Breast; Axilla
3.  Integrating Palliative Medicine into Comprehensive Breast Cancer Therapy – a Pilot Project 
Breast Care  2011;6(3):215-220.
Summary
Background
To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach.
Methods
A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation.
Results
Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues.
Conclusions
A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.
doi:10.1159/000328162
PMCID: PMC3132969  PMID: 21779227
Comprehensive cancer care; Palliative medicine; Simultaneous care; Shared care; Quality of life; Symptom control
4.  Facilitating Early Integration of Palliative Care into Breast Cancer Therapy. Promoting Disease-Specific Guidelines 
Breast Care  2011;6(3):240-244.
Summary
To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that ‘Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy’. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining ‘green flags’ for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.
doi:10.1159/000329007
PMCID: PMC3132974  PMID: 21779232
Comprehensive cancer care; Palliative medicine; Early integration; Quality of Life
5.  Financial Quality Control of In-Patient Chemotherapy in Germany: Are Additional Payments Cost-Covering for Pharmaco-Oncological Expenses? 
Breast Care  2011;6(2):120-125.
Summary
Background
Cost-covering in-patient care is increasingly important for hospital providers in Germany, especially with regard to expensive oncological pharmaceuticals. Additional payments (Zusatzentgelte; ZE) on top of flat rate diagnose-related group (DRG) reimbursement can be claimed by hospitals for in-patient use of selected medications. To verify cost coverage of in-patient chemotherapies, the costs of medication were compared to their revenues.
Method
From January to June 2010, a retrospective cost-revenue study was performed at a German obstetrics/gynecology university clinic. The hospital's pharmacy list of inpatient oncological therapies for breast and gynecological cancer was checked for accuracy and compared with the documented ZEs and the costs and revenues for each oncological application.
Results
N = 45 in-patient oncological therapies were identified in n = 18 patients, as well as n = 7 bisphosphonate applications; n = 11 ZEs were documented. Costs for oncological medication were € 33,752. The corresponding ZE revenues amounted to only € 13,980, resulting in a loss of € 19,772. All in-patient oncological therapies performed were not cost-covering. Data discrepancy, incorrect documentation and cost attribution, and process aborts were identified.
Conclusions
Routine financial quality control at the medicine-pharmacy administration interface is implemented, with monthly comparison of costs and revenues, as well as admission status. Non-cost-covering therapies for in-patients should be converted to out-patient therapies. Necessary adjustments of clinic processes are made according to these results, to avoid future losses.
doi:10.1159/000327354
PMCID: PMC3104902  PMID: 21673822
In-patient chemotherapy; Hospital economics; Cost-revenue calculation; German diagnose-related groups (G-DRGs); Additional in-patient payment
6.  Vacuum-Sealing as a Treatment Option for Severe Anthracycline Extravasation in a Breast Cancer Patient 
Breast Care  2008;3(5):347-348.
Summary
Background
Compared to peripheral venous access, central lines greatly reduce the incidence of cytotoxic extravasation. Although implantable vascular systems are widely used in oncology, extended extravasation lesions in cancer patients remain complicated.
Patient and Method
A 67-year-old female breast cancer patient suffered from an extended lesion of a catheter port extravasation. A vacuum-sealing therapy was initiated to accelerate the healing of the anthracycline-induced wound.
Result
The vacuum-sealing technique allowed a fast and successful treatment of the extravasation lesion.
Conclusion
Due to the myelosuppressive chemotherapy regimen, the risk of wound infections and prolonged healing processes is increased in cancer patients. Moreover, disruption or cancellation of anticancer therapies worsens the patients’ prognosis. To attenuate these complications the vacuum-sealing technique should be considered in wound management concepts.
doi:10.1159/000154141
PMCID: PMC2931107  PMID: 20824030
Extravasation; Vacuum-sealing therapy; Venous catheter port; Breast cancer; Chemotherapy

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