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Publications (20)46.27 Total impact
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ABSTRACT: We challenge epidemiologic knowledge regarding ovarian carcinoma (OC) by bridging the gap between clinical and autopsy data. Autopsy reports, histological slides and clinical files from 660 patients in whom OC was diagnosed from 1975-2005 were studied (autopsy cohort, n=233; Clinical Cancer Registry from the local gyneco-oncologic center, n=427). Out of the autopsy cohort, we identified four distinct subgroups of patients: 1) OC was diagnosed before autopsy, n=156 (67.0%). 2) OC was an incidental finding, n=16 (6.8%). 3) The ovarian tumors were not primary OC but rather metastases from other primary tumors; this revised diagnosis was first made by using current histopathological knowledge/techniques, n=24 (10.3%). 4) Death was directly due to OC in its final stage and OC was first diagnosed by autopsy, n=37 (15.9%); when these cases were added to the Clinical Cancer Registry to an adjusted OC incidence model, the autopsy cases comprised 8.8% of the adjusted cohort and almost doubled the percentage of oldest patients (≥80 years at diagnosis) from 4.9% to 9.3% (p=0.013). Epidemiological data from the 1970s-1990s may overestimate true incidence because up to 10% of carcinomas in the ovary were not properly classified. Patients who were first diagnosed with OC by autopsy comprise a distinct subgroup. These are patients who have not been seen by specialized oncologists and thus play no role in their perception of the disease. Nevertheless, these cases have impact on prevalence and incidence data of OC and in an era of reduced autopsy rates will probably be overlooked. Copyright © 2015. Published by Elsevier Inc.Gynecologic Oncology 05/2015; DOI:10.1016/j.ygyno.2015.05.013 · 3.69 Impact Factor
Article: Personal or first-degree family breast cancer history: which has higher impact on tumor detection and tumor size in breast cancer[Show abstract] [Hide abstract]
ABSTRACT: Purpose A woman's risk of developing breast cancer (BC) is increased if she has a personal history (PH) or family history (FH) of the disease. We compared the impact of the two risk factors PH and FH on tumor detection and tumor size at diagnosis in a cohort of BC patients. Methods The study cohort comprised 1,037 invasive BC patients (≤70 years at diagnosis). From these, 92 patients (8.5 %) had a positive PH and 151 patients (13.7 %) had a positive first-degree FH. Results Compared to the tumors of patients without PH or FH, the lesions of patients who had a positive PH or a positive FH were more often found by radiologic breast examinations (RBE) (PH: 49.4 %, FH: 43.4 %, no PH/FH: 26.2 %; both comparisons p p = 0.468). Patients with a positive PH or FH had smaller tumors compared with those without such a history (PH: 19.7 mm, FH: 19.6 mm, no PH/FH: 26.7 mm; p = 0.015/p p = 0.999). Conclusions In women with a positive FH or PH of BC, the increased awareness of BC risk led to the detection of smaller tumors compared to women who have not had this experience. However, comparison of the two risk factors showed that they had a similar impact on the RBE detection rate of BC lesions and that the tumor sizes were nearly identical.Archives of Gynecology and Obstetrics 12/2014; 291(6). DOI:10.1007/s00404-014-3592-y · 1.28 Impact Factor
Article: Self-detection and clinical breast examination: Comparison of the two "classical" physical examination methods for the diagnosis of breast cancer[Show abstract] [Hide abstract]
ABSTRACT: This is the first comprehensive analysis comparing specific aspects of tumor detection between the two "traditional" breast cancer detection methods self-detection (SD) and clinical breast examination (CBE). a) Which method is better in detecting smaller tumors? Both methods showed similar mean tumor diameters (SD: 22.1 mm vs. CBE: 21.9 mm; p = 0.991). b) Different frequency distributions of tumor locations would indicate that certain locations in the breast are more difficult to palpate: comparison of both methods showed comparable results (p = 0.835). c) General differences in tumor sizes with regard to certain locations would be of importance because the patients and/or the physicians could be educated to pay particular attention to certain locations during physical examination, where larger tumors tend to be found: tumors located in the central region were with 25.0 mm significantly larger than those in the peripheral regions of the breast (superior: 21.6 mm, p = 0.001; inferior: 21.6 mm, p = 0.015; lateral: 21.9 mm, p = 0.002; medial (20.9 mm, p = 0.001). Tumor sizes within the four peripheral regions did not differ significantly. d) Patients whose tumors were found by CBE were older than those whose tumors were found by SD (67 years vs. 60 years, p < 0.001). Conclusion: annual CBE should be an integral part of general medical care in older women. Copyright © 2014 Elsevier Ltd. All rights reserved.Breast (Edinburgh, Scotland) 12/2014; 24(1). DOI:10.1016/j.breast.2014.11.008 · 2.58 Impact Factor
Article: The impact of overweight and obesity on breast cancer: data from Switzerland, so far a country little affected by the current global obesity epidemic.[Show abstract] [Hide abstract]
ABSTRACT: This review presents results from the project "The Impact of Overweight/Obesity on Breast Cancer: data from Switzerland". Swiss data is interesting because the general female population is distinctive in two areas when compared to that of most other industrialized countries: Switzerland has comparatively low rates of overweight (22-23%) and obesity (7-8%) and has rather stable rates of overweight and obesity. The entire project comprised three major issues: (I) etiology of breast cancer (BC). There is a consistently shown association between obesity and postmenopausal BC risk in countries with high obesity prevalence rates in the literature. In our Swiss study group, however, we did not find higher rates of overweight and obesity in postmenopausal BC cases than in the general population. A possible explanation for this observation may be a curvilinear dose-response relationship between BMI and postmenopausal BC risk, so that an increased risk may only be observed in populations with a high prevalence of obese/very obese women; (II) tumor characteristics. BMI was significantly associated with tumor size; this applied not only to the cases where the tumor was found by self-detection, but also to lesions detected by radiological breast examinations. In addition, a higher BMI was positively correlated with advanced TNM stage, unfavorable grading and a higher St. Gallen risk score. No associations were observed between BMI and histological subtype, estrogen receptor status, HER2 status and triple negative BC; (III) patient compliance and persistence towards adjuvant BC therapy. Many studies found that the prognosis of overweight/obese BC patients was significantly lower than that of normal weight patients. However, failure of compliance and persistence towards therapy on the part of the patient is not a contributing factor for this observed unfavorable prognosis. In most therapy modes, patients with increasing BMI demonstrated greater motivation and perseverance towards the recommended treatment.
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ABSTRACT: BackgroundThe study evaluates frequency of and indications for disease-related radiotherapy in the palliative breast cancer (BC) situation and analyzes in which phase of the palliative disease course radiotherapy was applied.Patients & methods340 patients who developed distant metastatic disease (DMD) and died (i.e. patients with completed disease courses) were analyzed.Results165 patients (48.5%) received palliative radiotherapy (255 series, 337 planning target volumes) as a part of palliative care. The most common sites for radiotherapy were the bone (217 volumes, 64.4% of all radiated volumes) and the brain (57 volumes, 16.9%). 127 series (49.8%) were performed in the first third of the metastatic disease survival (MDS) period; 84 series (32.8%) were performed in the last third. The median survival after radiotherapy was 10 months. Patients who had received radiation were younger compared to those who had no radiation (61 vs. 68 years, p < 0.001) and had an improved MDS (26 vs. 14 months, p < 0.001). Compared to rapidly progressive disease courses with short survival times, in cases where effective systemic therapy achieved a longer MDS (≥24 months), radiotherapy was significantly more often a part of the multimodal palliative therapy (52.1% vs. 37.1%, p = 0.006).ConclusionsIn a cohort of BC patients with DMD, nearly one half of the patients received radiotherapy during the palliative disease course. In a palliative therapy approach, which increasingly allows for treatment according to the principles of a chronic disease, radiotherapy has a clearly established role in the therapy concept.Radiation Oncology 05/2014; 9(1):126. DOI:10.1186/1748-717X-9-126 · 2.36 Impact Factor
Article: Bone metastases in breast cancer: Frequency, metastatic pattern and non-systemic locoregional therapy[Show abstract] [Hide abstract]
ABSTRACT: Background The study evaluates the frequency of and indications for bone-metastases (BM)-related surgery and/or radiotherapy in the palliative breast cancer (BC) situation and analyzes in which phase of the palliative disease course surgery/radiotherapy was applied. Methods 340 patients who developed distant metastatic disease (DMD) and died (i.e. patients with completed disease courses) were analyzed. Results From the entire study cohort, 237 patients (69.7%) were diagnosed with BM. Out of these, 116 patients (48.9%) received BM-related radiotherapy and/or surgery during the palliative situation. Radiotherapy 108 patients (45.6%) received 161 series (range: 1–5) with 217 volumina (range: 1–8) on 300 osseous sites. At 75.3% of the radiated sites, the spine was the most frequent radiated location. Eighty-eight series (54.7%) were performed in the first third of the metastatic disease survival (MDS) period. The median survival after radiotherapy was 14 months (range: 0.2–121 months). Surgery In 37 patients (15.6%), 50 procedures (range: 1–4) were necessary to stabilize BM. The femur predominated with 56.0% of the procedures. Twenty procedures (40.0%) were performed in the first third of survival follow-up. The median survival after surgery was 13.5 months (range: 0.5–49 months). BC patients with BM had a significantly improved MDS when radiotherapy and/or surgery for skeletal metastases was embedded in the palliative approach (27.5 months vs. 19.5 months, p<0.001). From the 118 patients who had a MDS of ≥24 months, the majority (54.2%) had BM-related radiotherapy and/or surgery during the palliative course. Conclusions Metastatic BC has become increasingly viewed as a chronic disease process. In a general palliative therapy approach, which allows for treatment according to the principles of a chronic disease, non-systemic therapy for BM, in particular radiotherapy, has a clearly established role in the therapy concept.05/2014; 3(2). DOI:10.1016/j.jbo.2014.05.001
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ABSTRACT: This study evaluated the differences between breast cancer (BC) patients who present with primary distant metastatic disease (PMD) and those who develop distant metastases during the course of their illness (secondary metastatic disease [SMD]) with regard to clinicopathological characteristics, patterns of metastatic sites, palliative therapy and survival. Based on a cohort of patients with newly diagnosed BC (n = 1459), we analyzed all patients who had PMD (n = 92, 6.3%) and those who developed SMD (n = 277, 20.3%). There were no significant differences with regard to the patient's age in which metastatic disease had been diagnosed (PMD/SMD: 64 years/66 years, p = 0.19). The SMD group had more often triple-negative carcinomas (25.5%/7.3%, p = 0.019); there were no significant differences with regard to grading (p = 0.61), HER2 status (p = 0.67) and hormonal receptor status (p = 1.00). The mean number of metastatic locations was similar (2.3/2.3, p = 0.91). While patients with PMD usually initiated systemic therapy, patients with SMD received systemic therapy after diagnosis of metastatic disease less often (16.4%/2.6%, p < 0.001). Both groups received palliative chemotherapy similarly often (PMD/SMD: 62.8%/63.3%, p = 1.00). The mean number of palliative therapy lines was similar (PMD/SMD: 2.8/3.2, p = 0.39). Compared to patients with SMD, patients who had PMD had a significantly improved metastatic disease survival (p < 0.001). The one-year, two-year and five-year survival rates were as follows: 76.9%/60.3%, 58.2%/43.0%, 23.1%/10.6%. The median survival times were 18.5 months and 32 months. The poorer prognosis of patients with SMD may be explained by differences in clinicopathological features of the tumor, metastatic patterns, the use palliative therapy and drug resistance of the tumor cells which occurs in therapy-naïve PMD patients at a later phase of the disease course.Breast (Edinburgh, Scotland) 11/2013; 23(1). DOI:10.1016/j.breast.2013.10.007 · 2.58 Impact Factor
Article: Impact of breast cancer family history on tumor detection and tumor size in women newly-diagnosed with invasive breast cancer[Show abstract] [Hide abstract]
ABSTRACT: This study evaluated the impact of family history (FH) on tumor detection, the patient's age and tumor size at diagnosis in breast cancer (BC). Furthermore, we investigated whether the impact of FH on these features was dependent on degree of relationship, number of relatives with a BC history, or the age of the affected relative at the time that her BC was diagnosed. Out of the entire cohort (n = 1,037), 244 patients (23.5 %) had a positive FH; 159 (15.3 %) had first-degree relatives affected with BC and 85 patients (8.2 %) had second-degree affected relatives. Compared to women who had no BC-affected relatives, the tumors of women who had positive FH were more often found by radiological breast examination (RBE: 31.7 %/27.2 %, p = 0.008), and they were smaller (general tumor size: 21.8 mm/26.4 mm, p = 0.003; size of tumors found by breast self-examination (BSE): 26.1 mm/30.6 mm, p = 0.041). However, this positive effect of increased use of BC screening and smaller tumor sizes was only observed in patients whose first-degree relatives were affected (comparison with second-degree affected relatives: RBE: 43.8 %/24.7 %; odds ratio 2.38, p = 0.007; general tumor size: 19.3 mm/26.3 mm; mean difference (MD) -6.9, p = 0.025; tumor size found by BSE: 22.5 mm/31.0 mm; MD -8.5, p = 0.044). When more second-degree relatives or older relatives were diagnosed with BC, the tumors of these patients were similarly often detected by RBE (relationship: 24.7 %/27.2 %, p = 0.641; age: 33.7 %/27.2 %, p = 0.177) and had similar tumor sizes (general size: 26.3 mm/26.4 mm, p = 0.960; BSE: 31.0 mm/30.6 mm, p = 0.902) as those of women without a FH. Women with a positive FH generally use mammography screening more often and perceive changes in the breast earlier than women without such history. The increased awareness of BC risk decreases if the relationship is more distant.Familial Cancer 09/2013; 13(1). DOI:10.1007/s10689-013-9682-3 · 1.62 Impact Factor
Article: Breast cancer in women 80 years of age and older: A comprehensive analysis of an underreported entity.[Show abstract] [Hide abstract]
ABSTRACT: Background. Approximately 10% of breast cancer (BC) patients are over the age of 80. We present the first comprehensive review on this particular group of patients. Patients and methods. The treatments and disease courses of an unselected cohort of patients, whose age at first diagnosis was ≥ 80 years (n = 151), were compared to those of a group of women, who were aged 56-66 years (n = 372). Results. The group of elderly patients had larger tumors at first diagnosis (25 mm vs. 18 mm, p < 0.001) and higher disease stages (I: 31.1% vs. 44.1%, IV: 11.9% vs. 5.4%; each p < 0.001). There were no significant differences between both groups in terms of histologic subtype, grading, hormonal receptor status and HER2 status. The tumors of older patients were more often detected by clinical examination (38.9% vs. 17.0%, p < 0.001) and less often by mammography/sonography (10.4% vs. 29.9%, p < 0.001). The rate of patients who died of BC were similar in both groups (21.2% vs. 21.5%, p = 1.00). In the patients who had no evidence of metastases and who opted for primary non-surgical management (n = 21), the tumor could be stabilized without considerable morbidity in only 42.9%. Persistence to adjuvant endocrine therapy was comparable (83.0% vs. 88.3%, p = 0.357). In the adjuvant as well as in the palliative settings, elderly patients received less chemotherapy than younger ones (adjuvant: 1.6% vs. 23.3%; palliative: 32.3% vs. 68.4%; each p < 0.001). For palliative treatments only, elderly patients received fewer treatment regimens (≥ 3 therapy lines: 16.0% vs. 54.9%, p < 0.001). In those patients who died of BC, elderly women had inferior overall (25 vs. 54.5 months, p < 0.001) as well as metastatic-disease survival (11.5 vs. 19 months, p = 0.062). Conclusion. It must be ensured that appropriate standard therapies should not be routinely withheld in older patients based on erroneous perceptions regarding the biological nature of BC in the elderly and lack of knowledge about available therapy regimens. Physicians should consider that preservation of current life circumstances and maintenance of quality of life are frequently more important than "classical" hard medical facts such as survival times.Acta oncologica (Stockholm, Sweden) 10/2012; DOI:10.3109/0284186X.2012.731523 · 3.71 Impact Factor
Article: Impact of overweight and obesity on postmenopausal breast cancer: analysis of 20-year data from Switzerland[Show abstract] [Hide abstract]
ABSTRACT: Greater body fatness has been identified as a risk factor for postmenopausal breast cancer. For countries with low overweight/obesity rates, data on prevalence and time course of overweight/obesity in women with breast cancer in comparison to women in the general population is limited. The Swiss female population is distinctive for two reasons: (a) low rates of overweight/obesity compared with other western countries, and (b) no obesity epidemic, i.e. stable rates of overweight/obesity for more than 10 years. Overweight and obesity were analyzed in 51 to 80-year-old breast cancer patients initially diagnosed between 1990 and 2009. Patient data was derived from the Basel Breast Cancer Database (BBCD). This data was compared with the data of women of the same age from the four Swiss Health Surveys (SHS) conducted between 1992 and 2007. Differences between measured (BBCD) and self-reported (SHS) data were corrected using equations approved for the Swiss population. Of 958 postmenopausal BBCD patients, 32% were overweight and 20% were obese. Of the 14,476 women of the SHS, 38% were overweight and 17% were obese. In the BBCD, there was no change in the prevalence of overweight/obesity over the last 20 years. The four SHS show a convex curvature for obesity, i.e. a transient increase. No significant differences were observed between BBCD and corrected SHS data for overweight and obesity during this period. In this Swiss study group with a comparably low prevalence of overweight and obesity, no association between body fatness and postmenopausal breast cancer was observed.Archives of Gynecology 08/2011; 285(3):797-803. DOI:10.1007/s00404-011-2022-7 · 1.28 Impact Factor
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ABSTRACT: The term "familial male breast cancer" is often misleading, because in the breast cancer families reported in the literature, the vast majority of the patients were women and only a few were men. In this report, we present the rare case of a strictly defined familial male breast cancer (MBC) in which exclusively men were diagnosed with breast cancer. Three of four brothers developed the disease between the age of 46 and 64 years within a period of 21 years whereas all female relatives remained unaffected. The three affected men did not show the typical known clinical and genetic risk factors for MBC. An X-linked recessive inheritance may be possible in these cases. One way to potentially improve the identification of the causes of MBC could be a through a strictly studying families in which the male members were exclusively diagnosed with this malignancy. This approach emphasizes familial MBC as a distinct entity and not only as a variant of female breast cancer.Familial Cancer 11/2010; 10(1):73-7. DOI:10.1007/s10689-010-9400-3 · 1.62 Impact Factor
Article: Breast cancer with non-inflammatory skin involvement: Current data on an underreported entity and its problematic classification[Show abstract] [Hide abstract]
ABSTRACT: We evaluated 166 breast cancer cases with non-inflammatory skin involvement (NISI), which were classified in the TNM classification as T4b. The distribution of tumour sizes and stages was: < or =3 cm:24.1%, 3.1-5 cm:21.7%, 5.1-10 cm:33.1%, >10 cm:21.1%; stages:I/II:21.0%, III:43.4%, IV:35.6%. To assess the impact of NISI on axillary lymph node involvement (ALNI), we analyzed a sub-group of 50 patients with tumours < or =5 cm and compared them with a matched control group. NISI was found to be associated with increased ALNI (HR, 2.66; 95%CI, 1.59-4.63; p<0.0001). According to the inherent rules of tumour classification, only tumours with similar morphologic extent and prognostic significance should be combined. Since there is a high grade of heterogeneity, this basic tenet is clearly violated regarding breast cancer with NISI. Our proposal is to eliminate these tumours from the T4 category and to classify them simply by size (T1-3). Due to its prognostic significance, NISI should be indicated by an optional descriptor (e.g. S1).Breast (Edinburgh, Scotland) 12/2009; 19(1):59-64. DOI:10.1016/j.breast.2009.11.008 · 2.58 Impact Factor
Article: Is the current concept of recurrent ovarian carcinoma as a chronic disease also applicable in platinum resistant patients?[Show abstract] [Hide abstract]
ABSTRACT: The treatment of recurrent ovarian carcinoma (ROC) has become increasingly oriented according to the therapy principles of a chronic disease. We evaluated whether it is justifiable to also apply this concept to the treatment of platinum resistant patients with their known poor prognosis and short overall survival (OS). We analyzed the overall courses of 85 unselected ROC patients and defined the following groups: A, platinum resistant patients (n=39); subgroup A.1, those who received no or at maximum one line of palliative chemotherapy (n=15, 38.5%); subgroup A.2, those who received>or=two therapy lines (n=24, 61.5%); B, platinum sensitive patients, n=46. Group A had significantly lower OS than group B (median: 16 vs. 25 months; p=0.019). Group A.1 had significantly worse outcome compared to group A.2 (median: 5 vs. 21.5 months; p<0.001). The comparison between study group A.2 and group B showed comparable survival rates (p=0.738). Considering only the patients who had completed treatment courses, the median number of therapy lines administered was higher in group A.2 than in group B (4 vs. 3; p=0.008). There is not only the known dichotomy between platinum sensitive and resistant ROC patients, but rather also within the platinum resistant subgroup itself. There is a considerably large subgroup of platinum resistant patients who will subsequently enter a phase where multiple treatment programs will be considered and administered. These patients have similar survival rates compared to those from the platinum sensitive patient group and the therapy principles of a chronic disease are applicable.Archives of Gynecology 06/2009; 281(2):339-44. DOI:10.1007/s00404-009-1159-0 · 1.28 Impact Factor
Article: Systemic therapy developments and their effects regarding the current concept of recurrent ovarian carcinoma as a chronic disease.[Show abstract] [Hide abstract]
ABSTRACT: To demonstrate how the current concept of recurrent ovarian carcinoma (ROC) as a chronic disease resulted in developments in the systemic treatment strategies and outcome over time. We compared therapy type and course of a population-based cohort whose recurrent disease was diagnosed from 1990 to 2006. We divided the patients into two subgroups depending on the year of diagnosis of ROC (group A 1990-1997, n = 70; group B 1998-2006, n = 63). Both study groups showed similar results in survival (median recurrent disease-specific survival-A 18 months vs. B 19 months; P = 0.549). In group B, the patients had significantly fewer combination therapies administered [12.0% vs. 24.1%; odds ratio (OR) 0.43; 95% confidence interval (CI) 0.23-0.81; P = 0.0057], received more therapy lines (> or =3 lines 56.1% vs. 31.1%; OR 3.10; 95% CI 1.37-7.17; P = 0.005) and had significantly longer times of treatment (TT) in relation to the survival time (ST; mean TT/ST-ratio 57.5% vs. 47.5%; difference of the mean values B-A = -10.02; 95%CI -17.99 to -2.05; P = 0.014). The finding that survival of ROC patients could not be improved over time should not necessarily be viewed with undue pessimism regarding the general therapy situation. In the more recent study period, a similar outcome could be achieved with less aggressive treatment regimens, i.e., with fewer combination therapies and with longer treatment periods using less toxic agents. When a disease which requires periodic chemotherapy to control progressive course is increasingly treated with a strategy that permits stabilization with limited cumulative toxicity, then the requirements of a chronic disease management have been fulfilled.Archives of Gynecology 03/2009; 280(5):719-24. DOI:10.1007/s00404-009-0995-2 · 1.28 Impact Factor
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ABSTRACT: To depict a clear and coherent picture of the overall course of palliative treatment in an unselected study cohort over the course of time. We compared therapy type and course of 242 women whose distant metastatic disease was diagnosed from 1990 to 2006 and who ultimately died of the disease. We divided the patients into two subgroups depending on the year of diagnosis of metastases (group A: 1998-2006 vs. group B: 1990-1997). In both subgroups, there were no significant differences in the general type of treatment and the number of administered therapy lines (no systemic therapy: 12.9 vs.13.7%, p = 0.848; endocrine therapy only: 20.4 vs. 25.2%, p = 0.430; chemotherapy only: 18.4 vs.16.9%, p = 0.735; sequential combination regimen including endocrine therapy/chemotherapy/trastuzumab: 46.9 vs. 44.2%, p = 0.694; median: 2 lines). In the cases where chemotherapy was administered, there were no differences between the number of lines among older and younger patients (median: two lines; >or=70 years vs. <70 years: p = 0.269). The median metastatic disease-specific survival increased from 16 months in the period from 1990 to 1997, to 21 months in the period from 1998 to 2000 (p = 0.062). The number of patients who died from metastatic breast cancer without receiving any antineoplastic therapy was surprisingly high. The use of newer agents and regimens in the treatment of metastatic breast cancer was associated with an improved survival over time. Chemotherapy is a feasible option also among older patients.Oncology 02/2009; 76(4):247-53. DOI:10.1159/000205387 · 2.61 Impact Factor
Article: Distant metastatic breast cancer as an incurable disease: a tenet with a need for revision.[Show abstract] [Hide abstract]
ABSTRACT: Published reports provide level-III evidence in support of the hypothesis that distant metastatic breast cancer (MBC) might be curable in up to 3% of cases through a multidisciplinary approach including combination chemotherapy regimens in selected patients, usually young, and with limited metastases. Our study evaluates the rate and characteristics of long-term survivors based on a nonselective study cohort. We analyzed the data from 149 patients in whom distant MBC was diagnosed from 1990 to 1999. Five patients (3.4%) were long-term survivors (9-14 years after initial diagnosis of MBC) without any clinical evidence of disease. They had a 2-peaked distribution of age: 3 were 41-57 years old at the diagnosis of MBC and 2 were much older (76, 79 years). Median survival time after diagnosis of MBC was 152 (range, 109-172) months. Three patients had isolated metastatic lesions, although 1 patient had multiple organ metastases and another extensive bone metastases. In 4 of 5 cases, long-term survival was achieved without the administration of chemotherapy. Long-term survivors in MBC comprise a relatively heterogeneous group, and the factors which lead to the quite rare situation of long-term survival can hardly be evaluated systematically. Aggressive chemotherapy regimens appear not to be a key factor for survival. Furthermore, in a nonselective study cohort, some patients clearly are not only alive but also disease-free more than 12 years after initial relapse. This fraction may be small, but the chance for survival, and even for cure, truly exists.The Cancer Journal 01/2009; 15(1):81-6. DOI:10.1097/PPO.0b013e31818d8509 · 3.61 Impact Factor
Article: Tumor size and detection in breast cancer: Self-examination and clinical breast examination are at their limit.[Show abstract] [Hide abstract]
ABSTRACT: This study investigates to what extent tumor detection methods in breast cancer have changed and how this has influenced tumor size at initial diagnosis. 1054 breast carcinomas < or =5 cm, newly diagnosed between 1990 and 2006, were evaluated for the tumor detection methods used, namely self-detection (SD, n=568), clinical breast examination (CBE, n=212), and radiological breast examination (RBE, n=237), and their corresponding tumor sizes. During the study period, the proportion of cases found by RBE increased (p<0.001), while median tumor size decreased (1990-1992: 22 mm; 2005/2006: 17 mm. Spearman rho=-0.12, p<0.001). Nevertheless, SD remained the most frequent method of tumor identification (2005/2006: 48.9%). Carcinomas found by RBE were smaller (median size: 12 mm) than those found by the other two detection forms (SD: 21 mm, CBE: 21 mm; p<0.001). Within the different methods, only in RBE was an appreciable decrease in the size of the detected tumors observed during the study period (Spearman rho=-0.14, p<0.001; SD: Spearman rho=-0.05, p=0.19; CBE: Spearman rho=-0.05, p=0.43). Despite educational campaigns and high media coverage, the possibilities for improving the "classical" methods of tumor detection in breast cancer, self-detection and clinical breast examination, seem to be at their limit. The significant decrease in tumor size at time of detection observed in the last years is primarily only due to the increased use of breast imaging. Improved detection of smaller tumors may presumably be reached only by an increased use of radiological procedures.Cancer Detection and Prevention 10/2008; 32(3):224-8. DOI:10.1016/j.cdp.2008.04.002 · 2.52 Impact Factor
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ABSTRACT: Maximal tumor diameter (MD) is traditionally an important prognostic factor in breast cancer. It must be questioned, however, how well a one-dimensional parameter alone can represent the actual morphologic condition of a three-dimensional body. Along with the pathologically assessed MD and two perpendicular diameters (PDs) of a lesion, eccentricity (EF) and the three-dimensional parameters tumor volume (TV) and surface area (TSA) of 395 ductal invasive breast carcinomas of limited size (10-40 mm) were calculated. The dependent prognostic variable was axillary lymph node involvement (ALNI). MD, TV and TSA area were highly significant predictors of ALNI; these variables had similar levels of prediction accuracy (univariate analyses: MD: P = 0.0003, TV: P = 0.0009, TSA: P < 0.0001; multivariate analyses: MD: P = 0.0018, TV: P = 0.0109, TSA: P = 0.0009; pseudo R-squared values: MD: 0.42, TV: 0.39, TSA: 0.39). Despite certain variations in tumor shape, TV and TSA with similar MD, there is no evidence that three-dimensional pathologic measurements (TV/TSA) are more precise prognostic predictors of ALNI compared to the one-dimensional measurement alone.Breast Cancer Research and Treatment 07/2008; 116(2):257-62. DOI:10.1007/s10549-008-0115-1 · 4.20 Impact Factor
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ABSTRACT: The presence of skin involvement in breast cancer results in the classification of the tumor into the highest tumor category, and accordingly into the highest non-metastatic disease stage (current TNM classification: T4/stage III). This traditional view is no longer justifiable, as tumors that show non-inflammatory skin involvement (T4b) make up a considerably heterogeneous group with a high percentage of small-sized tumors. Classifying all lesions demonstrating this feature together results in the combination of tumors with widely differing prognostic and therapeutic implications into a single group. This violates the basic principle of the TNM concept in that only tumors exhibiting similar extension and prognosis should be grouped into one category/stage. Furthermore, the currently valid definitions of non-inflammatory skin involvement are misconceived for the substantial group of small tumors which often have ambiguous morphologic findings: the clinical classification depends on the subjective perception of the individual observer, and the pathologic staging considers histologic criteria that are not justifiable from a functional-morphological point of view. For these reasons, we strongly feel that there is a need to revise the current T4 category. We recommend that breast carcinomas currently classified as T4a-c should be eliminated from the T4 category and classified simply according to their tumor size (T1-3). The prognostically very unfavorable inflammatory carcinoma (T4d) should be maintained as the only clinicopathologic entity in the T4 category. This proposal, which will also lead to a revision of the stage III group, adheres more closely to the goals and principles of the TNM classification than do the current classification guidelines. Through the revision of the T4 category, the definitions and guidelines of inflammatory breast carcinoma should be adapted to the internationally accepted nomenclature.The Breast 01/2008; 16(6):625-36. DOI:10.1016/j.breast.2007.05.006 · 2.58 Impact Factor
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ABSTRACT: Previously published studies concerning autopsy findings in ovarian cancer failed to consider the broad differences in factors that influence the course of disease. Furthermore, those studies were conducted when the currently accepted standards in diagnostics and therapy had not been fully established. The objective of the current study was to determine the frequency and sites of metastases in patients with ovarian cancer with particular attention to the clinical course and therapy. Autopsy reports, histologic slides, and clinical files from 197 patients who died of ovarian carcinoma between 1975 and 2005 were studied. The distribution of metastatic sites (19 different organ sites) and metastatic patterns, with particular attention to clinical course (age, length of survival) and therapy (surgical treatment with curative intention, different chemotherapy regimens), were analyzed. Overall, 66.3% of patients had metastases to sites outside the abdominopelvic cavity. Patients who were aged >70 years, who had a disease duration <or=6 months, or who had received either no treatment or treatment without curative intention more often had metastases limited to the abdominopelvic cavity. This pattern of spread was observed most frequently in patients who had received current chemotherapy regimens (odds ratio, 3.5; P = .002). Compared with patients who had received chemotherapy according to previous standards, these patients showed a significantly increased incidence of liver metastases (P < .001). Autopsy data may yield important information concerning the metastatic potential of a malignancy and may assist physicians in making clinical management decisions. The results from the current indicated that declining autopsy rates during the last decades have limited the ability of physicians to evaluate the impact of new therapy regimens on the frequency and distribution of metastases through postmortem examination.Cancer 09/2007; 110(6):1272-80. DOI:10.1002/cncr.22919 · 4.90 Impact Factor
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Universitätsspital Basel
Bâle, Basel-City, Switzerland
- Institut für Pathologie
University Hospitals Birmingham NHS Foundation Trust
Birmingham, England, United Kingdom
- Department of Oncology


text:
Outside the palazzo, there are three flags, the European, the Venetian, and the Mexican – the last one is blood-stained.
palazzo Grassi barely beat the Guggenheim Museum for the honors.
François Pinault, at the opening of the palazzo Grassi two years ago, exhibited his own skull X-rayed by Piotr Uklanski.

subset: commoncrawl


text:
A device for externally fixing bones and joints. The device is made of multiple connectable cylindrical sleeves, each housing a hollow cylindrical member. Both the cylindrical sleeves and their internal cylindrical members are provided with holes in their cylindrical walls, for insertion of bone-anchoring pins.
1. A device adapted to be used externally for fixing bones and joints of a patient, comprising:
(a) a plurality of cylindrical sleeves, each comprising a cylindrical wall provided with holes for receiving a bone-anchoring member therethrough, and each including a front extremity and a rear extremity, said sleeves being releasably connectable to one another in succession by connecting said rear extremity of a first one of said sleeves with said front extremity of a second one of said sleeves in order to form a tubular tutor; and
(b) a plurality of hollow cylindrical members, one houseable in each of said sleeves, each comprising a cylindrical wall provided with holes for receiving a bone-anchoring member therethrough.
2. The device of claim 1, further comprising a joint means connectable to a terminal sleeve in said tubular tutor for articulating said tubular tutor about a knee of a patient.
3. The device of claim 2, wherein said joint means comprises a plurality of lateral members pivotally connected to a linking member for linking said lateral members, said linking member having a substantially square cross-section and comprising a plurality of orifices for receiving screws to connect said lateral members to said linking member.
4. The device of claim 3, wherein said plurality of orifices comprise two orifices oriented perpendicularly to one another.
5. The device of claim 3, wherein said plurality of orifices comprise two orifices oriented parallel to one another.
6. The device of claim 3, wherein at least one of said lateral members comprises a first portion and a second portion, said first portion comprising a first hole connected to a slit.
7. The device of claim 6, wherein said second portion comprises a plurality of arms defining a space therebetween, said space extending substantially through the thickness of said at least one lateral member.
8. The device of claim 7, wherein at least one of said arms comprises a second hole for receiving a screw to connect said at least one lateral member with said linking member.
9. The device of claim 8, wherein said first portion further comprises a third hole extending perpendicularly to said first hole.
10. The device of claim 9, wherein said second hole and said third hole extend parallel to each other.
11. The device of claim 10, wherein said orifices are located on a common surface of said linking member.
12. The device of claim 1, wherein each of said cylindrical sleeves comprises a front portion including said front extremity, a rear portion including said rear extremity, and a middle portion disposed between said front portion and said rear portion, each of said front portion, said middle portion, and said rear portion comprising an internal surface and an external surface.
13. The device of claim 12, further comprising an end member adapted to be screwed onto said rear portion of one of said cylindrical sleeves positioned at a terminal extremity of said tubular tutor.
14. The device of claim 12, wherein said front portion comprises threads disposed on said external surface of said front portion, and said rear portion comprises threads disposed on said internal surface of said rear portion.
15. The device of claim 15, wherein said middle portion comprises a plurality of bridges for connecting said front portion with said rear portion, and a circular member connecting said bridges to said front portion.
16. The device of claim 15, wherein said circular member comprises a plurality of notches disposed along the periphery of said circular member, said notches extending toward said rear portion.
17. The device of claim 16, wherein said notches are semi-circular in shape.
18. The device of claim 17, wherein said plurality of bridges comprise two bridges, said two bridges being disposed diametrically opposite to each other and providing, as said holes in said cylindrical wall of each of said plurality of cylindrical sleeves, at least two circumferential slots between said two bridges for receiving said bone-anchoring member therethrough.
19. The device of claim 18, wherein said holes provided in each of said hollow cylindrical members comprise a plurality of diametrically opposed holes, for receiving said bone-anchoring member therethrough to be rotated perpendicularly to said tubular tutor within said one of said two circumferential slots in order to be secured in one of said notches.
20. The device of claim 19, wherein said middle portion comprises a shoulder section provided on said internal surface thereof, said shoulder section being adjacent to said front portion.
21. The device of claim 20, wherein each of said hollow cylindrical members comprises an anterior extremity and a posterior extremity, said anterior extremity abutting said shoulder section and said posterior extremity abutting a front extremity of a successive cylindrical sleeve when said plurality of cylindrical sleeves are releasably connected to form said tubular tutor.
22. The device of claim 21, wherein said diametrically opposed holes are located adjacent to said anterior extremity and away from said posterior extremity.
23. The device of claim 18, wherein the diameter of said semi-circular notches is substantially equal to the diameter of said bone-anchoring member.
24. The device of claim 12, wherein the length of each of said hollow cylindrical members is substantially equal to the length of said middle portion.
25. The device of claim 12, wherein each of said hollow cylindrical members and said middle portion each has an external diameter and an internal diameter, said external diameter of each of said hollow cylindrical members being substantially equal to said internal diameter of said middle portion.
26. The device of claim 12, wherein the diameter of said front portion is substantially equal to the diameter of said rear portion.
27. The device of claim 12, wherein the diameter of said middle portion is greater than the diameter of said front portion.
28. The device of claim 12, wherein the diameter of said middle portion is less than the diameter of said rear portion.
29. The device of claim 12, further comprising a compressor-distracter means for compressing and distracting said cylindrical sleeves.
30. The device of claim 29, wherein said compressor-distracter means comprises:
(a) an elongate axial member comprising an external surface, said external surface having threads thereon;
(b) at least one cylindrically shaped lateral bracket threaded at each end of said elongated axial member; and
(c) a first nut fixedly screwed onto said elongate axial member.
31. The device of claim 30, wherein said first nut is substantially centrally positioned so as to divide said elongated axial member into a first section and a second section, each said first section and said second section having threads thereon.
32. The device of claim 31, wherein said threads on said first section spiral in a clockwise direction, and said threads on said second section spiral in a counter-clockwise direction.
33. The device of claim 31, further comprising a second nut screwed on each of said first section and said second section.
34. The device of claim 30, wherein each said lateral bracket comprises a long portion and a short portion, each having a diameter portion wherein the diameter of the short portion is greater than the diameter of said long portion.
35. The device of claim 34, wherein said short portion of a first one of said brackets is adapted to be screwed on said front portion of one of said cylindrical sleeves, and said short portion of a second one of said brackets is adapted to be screwed on said rear portion of another one of said cylindrical sleeves.
1. Field of the Invention
The present invention relates to a device for externally setting bones and joints, by the compression or distraction of bone fragments.
2. Description of the Prior Art
Various devices for externally setting bones are known in the art; all of these devices have disadvantages of one type or another. One such device, a rigid tubular device, cannot be used in different positions. Other devices can be used in different positions; however, because they comprise multiple connected pieces, and are of considerable complexity, these devices are too heavy, and lack sufficient strength for their intended purpose.
The device of the present invention overcomes the indicated deficiencies of the devices of the prior art. It comprises a solid tubular device which can be easily manipulated, and is well suited for placing in various positions covering different spacial arrangements. It is also superior by virtue of being lighter in weight than the devices of the prior art.
The device of the present invention is a compression system, available for use wherever needed, and is capable of applying a significant compression force against bones. The device comprises a rigid tubular tutor, or guide, for bone-anchoring members, such as bone-contacting pins; the guide permits such pins, passing through the guide, free rotation around the guide perpendicular to its axis, thereby allowing each pin to be fixed in the proper position.
FIG. 1 is a perspective view of the cylindrical sleeve of the tubular guide of the present invention.
FIG. 2 is a perspective view of the sleeve of FIG. 1 from a different angle.
FIG. 3 is a side elevation view of the sleeve of FIG. 1.
FIG. 4 is another side elevation view of the sleeve of FIG. 1.
FIG. 5 is a perspective view of the internal cylinder of the present invention.
FIG. 6 is a partial cross-sectional view of the internal cylinder of FIG. 5, along its axis.
FIG. 7 is a perspective cross-sectional view of the sleeve of FIG. 1.
FIG. 8 is an elevational cross-sectional view of the sleeve FIG. 1.
FIG. 9 is a perspective cross-sectional view of two successively connected cylindrical sleeves, one housing an internal cylinder to form a tubular guide of the present invention.
FIG. 10 is an elevation cross-sectional view of the sleeves and cylinder shown in FIG. 9.
FIG. 11 is a perspective view of a second embodiment of the cylindrical sleeve.
FIG. 12 is a perspective view of a third embodiment of the cylindrical sleeve.
FIG. 13 is a perspective view of a second embodiment of the internal cylinder, corresponding to the cylindrical sleeve of FIG. 11.
FIG. 14 is a perspective view of a third embodiment of the internal cylinder, corresponding to the cylindrical sleeve of FIG. 12.
FIG. 15 is a top plan view of the cylindrical sleeve of the present invention, showing the capability of the sleeve for receiving the bone-anchoring pin inserted therethrough in various positions;
FIG. 16 is a side elevational view of a bone-anchoring pin of the present invention.
FIG. 17 is a side elevational view of a second embodiment of the bone-anchoring pin.
FIG. 18 is a side elevational view of the connecting bar of the present invention.
FIG. 19 is a perspective view of the T-shaped key for adjusting the joint screws of the present invention;
FIG. 20 is a side elevational view of a third embodiment of the bone-anchoring pin.
FIG. 21 is a perspective view of a terminal element for the tubular guide of the present invention.
FIG. 22 is a perspective view of the joint of the present invention.
FIG. 23 is a perspective view of a lateral member of the joint, and of two screws for insertion therein.
FIG. 24 is one embodiment of the linking member of the joint.
FIG. 25 is a second embodiment of the linking member.
FIG. 26 is a perspective view of one of the brackets of the compressor-distracter of the present invention.
FIG. 27 is a perspective view of the other of the brackets of the compressor-distracter.
FIG. 28 is a perspective view of the tension screw, and of the fixed screw-nut and the mobile nuts mounted on the tension screw.
FIG. 28' is a perspective view of the device of the invention, in use for setting bones, wherein the tubular guide consists of successively connected cylindrical sleeves.
FIG. 29 is a perspective view of the device of the invention, in use for setting bones, incorporating a compressor-distracter for connecting cylindrical sleeves.
FIG. 30 is an alternative embodiment of the device in use.
The tubular guide of the device of the invention comprises standard sleeves of the type shown in FIG. 1; each sleeve comprises a hollow cylinder, having threaded edges for successive connection of multiple sleeves to one another.
Specifically, each sleeve is a hollow cylinder pearled by an anterior, or front extremity X and by a posterior, or rear extremity Y, these two extremities being connected by section Z.
As shown in FIG. 8, the external diameter of front extremity X, and the external diameter of section Z, are both greater than the external diameter of rear extremity Y. Further, the internal diameter of front extremity X is greater than the internal diameter of section Z, and the internal diameter of section Z is greater than the internal diameter of rear extremity Y. Shoulder E is situated between rear extremity Y and section Z.
Front extremity X comprises internal thread 2, and rear extremity Y comprises external thread 1. The diameter of external thread 1 is less than that of internal thread 2, thereby permitting threaded connection of successive sleeves by their respective threads 1 and 2, as shown in FIG. 28, to form the tubular guide.
As shown in FIGS. 3, 4, and 7, the sleeve further defines circumferential slot 3 spanned by two budges 4. Bridges 4 join front extremity X and rear extremity Y.
As shown in FIG. 15, slot 3 allows a pin to pass through the sleeve, and to rotate around the sleeve, perpendicularly to the axis of the sleeve, before the pin is screwed into bone. The pin is screwed into bone by means of thread 9, shown in FIG. 16.
The edge of slot 3 is provided with several semicircular notches 5. As shown in FIG. 28, these notches are sized according to the diameter of the pin, and serve to receive the pin, to be lodged and locked into the necessary position.
FIG. 5 shows a hollow cylinder provided with front edge M and rear edge N. FIG. 6 shows a sagittal section of this cylinder along its axis. This cylinder is characterized by a predetermined thickness, and by both length and diameter less than that of the sleeve. The length of this cylinder is equal to that of section Z, and its external diameter is comparable to the internal diameter of section Z. This cylinder may thereby be housed in section Z of the sleeve as an internal cylinder, situated between threaded edges 1 and 2, and may rotate freely within the sleeve around the sleeve's axis.
This internal cylinder is provided with two diametrically opposed holes 7, which appear through slot 3 whenever the cylinder is housed within the sleeve. Both holes 7 have a diameter equal to that of the transbone pin, and are situated at distance D from front edge M of the internal cylinder; distance D is less than half of the length of the internal cylinder.
As shown in FIGS. 9 and 10, holes 7 are visible through slot 3 when the internal cylinder is housed in the sleeve. Accordingly, a pin, when inserted into slot 3 perpendicularly to the axis of the sleeve, can pass through slot 3, and through both holes 7, in a path perpendicular to the common axis of the sleeve and of the internal cylinder; the pin, which may be provided with a thread, may be passed through slot 3 and holes 7 to contact the bone.
Prior to being screwed into the bone, a pin inserted through slot 3 and through holes 7 of the internal cylinder may be rotated freely around the axis of both the sleeve and the cylinder. Such rotation correspondingly compels the cylinder also to rotate; as shown in FIG. 15, rotating the pin in this manner leads the pin past notches 5 of slot 3; such rotation of the pin is limited on each side of the sleeve by bridges 4.
As shown in FIG. 10, the presence of a pin inserted through the sleeve, and through the internal cylinder housed therein, prevents front edge M of the internal cylinder from contacting shoulder E. The pin is lodged in one of the notches provided in slot 3, thereby preventing the internal cylinder from advancing closer to rear extremity Y. As a result, rear edge N of the internal cylinder extends into front extremity X; the pin is accordingly fixed in the bone at a predetermined angle.
Pins may be screwed into the bone at the required position by means of a brace, or, alternatively, may be screwed into a forward bore made by a bit. As shown in FIG. 9, a pin is locked into place in the sleeve through which it has been inserted by connection of the sleeve to another sleeve.
Successive connection of a second sleeve to a first sleeve causes surface 6 of second sleeve rear extremity Y to engage rear edge N of the internal cylinder housed in the first sleeve; threaded connection of the two sleeves will thereby advance the internal cylinder housed in the first sleeve toward shoulder E of the first sleeve.
When a first sleeve and second sleeve are connected, surface 6 of the externally threaded rear extremity Y of the second sleeve pushes against the internal cylinder of the first sleeve; a pin in the first sleeve is accordingly immobilized by this internal cylinder in requisite notch 5 of the first sleeve. In this manner, where a pin is provided in a sleeve for implantation in the bone, the pin can be secured in the proper position simply by connection of the sleeve through which it has been inserted to a successive sleeve.
The use of both sleeve and internal cylinder permits the assembly of a rigid tubular guide, or tutor, whose length can be modified as required; as shown in FIG. 28, this configuration further provides for orientation of each pin according to the position of bone fragments.
Accordingly, a straight tutor can be used to set non-aligned bone fragments. The same guide is suitable for setting two long bones.
As shown in FIG. 28', pins can be rotated within the tubular guide to allow for different positioning of such pins, in various angles. Because the pins can be rotated in this manner in the tubular guide, a single pin can be used to connect two independent guides without intermediate articulation being required.
A particular example of this capability is provided in FIG. 30, which shows connecting bar or pin 32 securely joining two straight tubular guides T1 and T2, situated in two different planes, without requiring any joints. One end of pin 32 is secured in sleeve M1 of tubular guide T1, with the other end being secured in sleeve M2 of tubular guide T2.
The configuration of elements shown in FIG. 30 may be provided by first securing pin 32 in sleeve M1, of tubular guide T1. After pin 32 is secured in guide T1, in this manner, pin 32 may then be secured in sleeve M2 of tubular guide T2.
Multiple tubular guides, situated in different planes, can be connected in similar fashion. Accordingly, a system of multiple connected tutors can be provided without the need for supplemental connective apparatus, which can cause the bone setting to be fragile.
FIG. 11 shows another embodiment of the cylindrical sleeve, differing from the embodiment shown in FIGS. 1-4 in that front extremity X is longer in the embodiment of FIG. 11 than in the embodiment of FIGS. 1-4. The greater length of front extremity X increases the distance between two adjacent pins where such two pins, secured in separate tubular guides, converge at a single point in the bone.
FIG. 12 shows yet a third embodiment of the cylindrical sleeve, characterized by front extremity X being still longer than front extremity X of the embodiment shown in FIG. 11.
FIGS. 13 and 14 show internal cylinders corresponding to the cylindrical sleeves of FIGS. 11 and 12, respectively. For each such cylinder, hole 7 is positioned at fixed distance D from front edge M.
FIGS. 16 and 17 show different embodiments, varying in diameter and length, of the pin to be secured in the tubular guide of the device of the invention. As shown specifically in FIG. 16, the pin may be provided with point 8; point 8 is followed by thread 9, which may be any of various lengths. The other end of the pin is provided with rectangular tip 10, followed by neck 1 of lesser diameter. Neck 11 may serve as a grip for a brace utilized to drive the pin into the bone.
FIG. 18 shows a connecting bar. This bar may be any of various
FIG. 19 shows a T-shaped key. The base of the T is provided with square gap 12 for engaging screws V1 and V2 of the joint shown in FIG. 22.
FIG. 20 shows a pin of any of various dimensions, provided with smooth tip 13, and with thread 15, also of varying length. This pin requires a bore already provided in the bone for insertion; it may be screwed into the bone by the T-shaped key shown in FIG. 19.
FIGS. 21-25 show supplemental connective elements which are appropriate for the device of the invention where such apparatus is required to overcome certain technical difficulties.
FIG. 21 shows a terminal element provided, at one end, with thread 1 for connection to the terminal sleeve in the tubular guide. This terminal element comprises cylindrical section K, situated between bar W and end section Y2.
Bar W extends along the axis of cylindrical section K, in a direction perpendicular to the surface of a cylindrical cross-section of cylindrical section K. Bar W serves to attach the terminal element of FIG. 21 to the joint shown in FIG. 22.
End section Y2, provided with external thread 1, has a diameter corresponding to that of rear extremity Y of a cylindrical sleeve; like rear extremity Y, section Y2 is also threadedly connectable to front extremity X of a cylindrical sleeve. Orifice 6 may be used to tighten the connection between end section Y2 and extremity X of a cylindrical sleeve.
The joint shown in FIG. 22 is a "kneecap" joint, comprising three aligned articulated elements interconnected by two pivotal axes; specifically, lateral members R1 and R3, which are substantially identical, are joined by intermediate, or linking member R2.
As shown in FIG. 23, each of lateral members R1 and R3 is a parallelepipedon, characterized by rectangular sections of length L, width P, and thickness T.
Each of lateral members R1 and R3 is provided, at one of its extremities, with orifice 19, perpendicular to the axis of screw V1. Connecting orifice 19 to the front edge of each lateral member is slit 20, for receiving a connecting bar.
Slit 20 is tightened by means of screw V2, aligned perpendicularly to slit 20. Specifically, screw V2 passes through orifice O, which intersects segment L2 perpendicular to the plane in which slit 20 L is situated. Screw V2 serves to tighten orifice 19 on a connecting bar inserted therein.
Both screw V1 and screw V2 are threaded at their distal ends for tightening in their respective orifices.
The other extremity of each of lateral members R1 and R3 is characterized by a gap of length L, width P, and width S, for receiving linking member R2. Linking member R2 is hinged to each of lateral members R1 and R3 in its gap, through orifices 17 and 18, by screw V1 ; orifice 18 as internally threaded. This arrangement allows for the articulation of these members.
Linking member R2 is a parallelepipedon with two sets of rectangular opposed lateral faces of length Q, and opposed square terminal surfaces having sides of length S. Orifices 21 and 22 are provided at each end of linking member R2 to allow the previously discussed articulation with lateral members R1 and R3.
FIG. 24 shows one embodiment of linking member R2, wherein orifices 21 and 22 are situated on lines which are perpendicular and non-intersecting.
In another embodiment of linking member R2, shown in FIG. 25, orifices 23 and 24 are aligned in a single plane, through opposed faces of linking member R2 ; this configuration provides for articulation of lateral member R1 and R3 in a single plane. One of lateral members R1 and R3 can receive bar W in its orifice 19. The other of these two lateral members can receive a connecting bar secured in another joint which is connected to a separate tubular guide.
Thus, the two orifices 19, of respective lateral member R1 and R3 in a particular joint, can be aligned either in perpendicular or in parallel, depending upon whether orifices 23 and 24 of linking member R2 are aligned in perpendicular or in parallel. Depending upon different dispositions of the joint, the multiple possible configurations of elements allow a wide variety of possible connections between different tubular guides. The joint is secured in position by screws V1 and V2, in the manner previously discussed.
The previously discussed terminal element of FIG. 21, and the joint of FIG. 22, can be provided at the extremity of each tutor, or tubular guide, to facilitate connection. Two joints can be joined by a connecting bar. Each joint can be varied according to the intermediate pieces of which it is constructed, thereby permitting two assembled joints considerable spacial mobility.
The device of the invention may include a compressor-distracter situated along the axis of the tubular guide. In this position, the compressor-distracter may be used to impart a significant tractor force to the compression system.
As shown in FIGS. 26-28, the compressor-distracter comprises three principal elements and two nuts. Specifically, the compressor-distracter includes two lateral, cylindrical hollow brackets, each provided with an internal thread. Each of these cylindrical brackets has an extremity externally threaded for connection to the threaded edges of tubular guide sleeves.
FIG. 26 shows one of these brackets, comprising hollow cylinder A, characterized by wall 25. Wall 25 is of a specific thickness, and is provided with longitudinal, internal thread 26. One end of the bracket comprises adjustment edge Y1.
Adjustment edge Y1 is provided with external thread 27, and has the same diameter as rear extremity Y of a tubular guide cylindrical sleeve, thereby permitting connection with the tubular guide. Specifically, as shown in FIG. 29, this bracket of the compressor-distracter can be threadedly connected by means of adjustment edge Y1, with front extremity X of a tubular guide cylindrical sleeve.
FIG. 27 shows a second bracket, comprising hollow cylinder B. Hollow cylinder B is identical to hollow cylinder A, except in being provided with internal thread 29, which is opposed to internal thread 26 of hollow cylinder A.
Outer end X1 of this second bracket has the same diameter as front extremity X of a tubular guide cylindrical sleeve. Accordingly, as shown in FIG. 29, this second bracket can be threadedly connected by means of outer end X1 to rear extremity Y of a tubular guide cylindrical sleeve.
Cylinders A and B are provided, respectively, with orifices 28 and 31, suitable as supports for tightening the brackets.
FIG. 28 shows an axial member, or tension screw, which may also be referred to as an intermediate tension screw, externally and longitudinally threaded along its entire length. The tension screw serves as an intermediate element for connection of the cylindrical brackets of the compressor-distracter. This tension screw is provided with opposed extremities for threaded connection with the interior of the cylindrical brackets along the common axis of these brackets and the tension screw.
For receiving the threaded, opposed extremities of the tension screw, the two cylindrical brackets are, as indicated, internally threaded with opposed threads 26 and 29, respectively. Corresponding to the opposed threading of the two cylindrical brackets, the tension screw is provided with opposed threaded sections CA and CB, separated by fixed screw-nut EO.
Accordingly, turning the tension screw in one direction will direct force toward the cylindrical brackets and their respective tubular guides. The result will be compression of the bone fragments, respectively associated with each of these cylindrical brackets, along the axis of the tubular guide. Correspondingly, turning the tension screw in the opposite direction will cause distraction, thereby withdrawing these cylindrical brackets.
As shown in FIG. 29, mobile nuts E1 and E2 are situated on the tension screw. Each is in contact with one of the cylindrical brackets at its extremity, thereby preventing the three aligned members of the compressor-distracter from unwanted movement in relation to one another.
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Articles tagged world trade center
24 Sep 2010 // 6:15 AM
Until 2004, Oliver Stone could never be accused of shying away from anything. Once he did, the critics pounced.READ more
//Mixed media
Colette Carr "Static" (video) (Premiere) // Music
House of Blondes "First of July" (audio) (premiere) // Music
Digisaurus 'No More Room For Love' (EP stream) // Music
Eszter Balint 'Airless Midnight' (album stream) (premiere) // Music
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On translation, transliteration and Greek letter magick.
Tarot and the Death card around Samhain.
What is "dark fluff?"
Shapeshifting, familiars, and animal companions.
On viewing magical asanas and forms as kata. Continue reading
On translation, transliteration and Greek letter magick.
Tarot and the Death card around Samhain.
What is "dark fluff?"
Shapeshifting, familiars, and animal companions.
On viewing magical asanas and forms as kata. Continue reading
Chaos magick is all grown up, and if there are punk zen monks, there are also chaote monastics.
Are you a bad witch? Bad Witches is a new blog and it's off to a strong start, with posts on hacking the tarot, and what Jove's up to on Thor's day and how you can make harness that money magick goodness. (Or is that badness?)
Mindfulness meditation centred around Baphomet? Count me in.
Check out Sable Aradia's great two part (so far) series on sex magick, "A Sticky Subject: Teaching Sex Magick: Part I" and "Part II". Important reading. Continue reading
The History of British Magick After Crowley: Kenneth Grant, Amado Crowley, Chaos Magic, Satanism, Lovecraft, The Left Hand Path, Blasphemy and Magical Morality, by Dave Evans
Hidden Publishing, 97895523700, 435 pp. (incl. appendix, bibliography and index), 435 pp. (incl. appendix, bibliography and index)
I've known Dave Evans online for a number of years, so I was excited when he said his book had finally been published, and looked forward to reading it. His doctoral dissertation in history forms the basis for The History of British Magick After Crowley, and as such it is structured in an academic format, opening with a detailed explanation of his methodology, and his involvement with both magick and academia.
Magicians are not known for their strict adherence to objective truths, and much of the traditions are oral, or rely on in-person contact. The academic approach taken with his work may seem threatening to some, challenging myths and records which have endured simply because they're oft repeated. Evans has done an admirable job sifting through the available data to bring us what can be verified, and provided a detailed record of his sources. Continue reading
The Triumph of the Moon: A History of Modern Pagan Witchcraft, by Ronald Hutton
Oxford University Press, 416 pp. (plus notes and index), 1999
Before I requested this book, I had heard a little bit about it. Some of my acquaintances said it was the best book on Pagan history they had ever read. Others said it was thing they had ever heard of.
The book begins by demolishing some long held, well-loved beliefs about the words "pagan" and "heathen."
Mr. Hutton comes to this research from an angle which has been sadly lacking on the subject of Paganism – that of a historian. He has no axe to grind, no sacred cows to protect, no oaths of secrecy to prevent him from looking at every angle. Continue reading
It is early evening, in mid-March, in Maryland. I am sitting in my bedroom, gazing out my window at the melting patches of snow which still cover large portions of the ground in these parts-and at the horrible gashes cut into the breast of Earth-Mother by the bulldozers of developers who have converted the beautiful fields, forest, and hedge- rows behind my house into the site of a future subdivision. The sun has just set behind the hill I call, privately, Cerne's Knoll, for the deer I used to see there; now there are no deer, and precious few trees, left of this formerly vibrant woods. I reflect that the developer responsible is considered a pillar of his community-he sits on the board of trustees of my undergraduate college-and his church. I think on the connection between church and community: and on the at times chasmic dis-connection between church and land-community, and between the traditional Christian church and those who are not, whether by choice or happenstance, part of it. Continue reading


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retro shapesby VanessaGF
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The PMA Store is open during regular museum hours.
Monday through Thursday, Saturdays, and Sundays: 10am - 5pm
Fridays: 10am - 9pm
Third Thursdays: 10am - 9pm
When Arman (Vincent Macaigne) literally runs into Amélie (Maud Wyler) while jogging, the collision sets into motion an offbeat love affair that takes unexpected twists and turns of the heart. Told through monologues, neatly divided chapters, and banter about pop culture and the art world, this quirky French rom-com explores what it's like to be young, in love, and engaged with a wild and unpredictable world.
The music of George Gershwin is brought to vivid life in one of cinema's great musicals, showing at the PMA for one night only. Gene Kelly stars as a painter living in Paris, who pals around with musicians and falls in love. This testament to the golden age of MGM musicals is a large, lavish production, rendered in bold Technicolor, and can only be truly appreciated on the big screen. An American in Paris swept the Academy Awards for 1951 and was named one of the greatest movies of all time by the American Film Institute in 1998.
Busby Berkeley's famed choreography, Sol Polito's camerawork—particularly those astounding overhead shots—and the extraordinary production values of Depression-era Warner Brothers are at the heart of this early and extraordinary example of the American film musical. The story takes us behind the scenes to look at the drama and glamour in the staging of a Broadway musical, and was so effective in this aim that it won raves from New York critics as well as Hollywood.


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Personalized Ice Cream Bowls - Family Characters
Handmade S'Mores
Personalized Vacation Fund Jar
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Personalized Classy Guy Tie T-Shirt
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Personalized Family Name and Initial Glass Coaster
Personalized Light-Up Birthday Candles Mug - Birthday Gifts
Personalized His Year to Remember T-Shirt
Personalized Photo Message Mug
Personalized 4 in 1 Wine Tool
Personalized You + Me Mens Boxer
Personalized Popcorn Popper
Personalized Mustache Pilsner
Personalized Just for Dads Photo Frame
Chocolate, Vanilla, & Red Velvet Cake Pops - 6 Count
Put the hammer down and step away from the piggy bank. Finding cool gifts for men under $25 doesn't require breaking the bank. In fact, having a predetermined price point often makes buying a gift easier because your search has become targeted.
One of the best, and most economical, ways to keep a gift for a man under $25 is to add a homemade element to the product. Items like coupon books let you add your own message, personalizing the gift in a special way. Does the man attend a lot of sporting events or concerts? Buying him a ticket stub book lets him keep mementos from past events in one place. Jotting down a quick note on whether his team won or lost and who attended the event with him, lets him look back and remember fun times.
When buying a gift for a guy, always consider the things he likes spending his free time on. He is a reader? Lots of great books can be found under $25 including humorous one (potty and otherwise.) Does he get together weekly with the boys to play poker? Perhaps a personalized beer mug to drink from during the game or a fun set of shot glasses would be appropriate.
Your budget may be limited but your choices are limitless when shopping for a gift for a guy under $25.


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Cheap Home Decor: Crafting with Paper
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Beaded Tablecloth Weights
By: Bead Studio
We are adding the craft to your Craft Projects.
The project was added to your Craft Projects.
Click here to view your Craft Projects.
These tablecloth weights from The Bead Studio combine function and style. Put them on your holiday table this year and no one will even know they are more than a fun decoration.
- 4 badge clips
- 20 6mm split rings
- 40 headpins
- 4 eyepins
- 4 large charms
- 48 large glass beads
- Attach 5 split rings together & hook to the badge clip.
- Add charms to the loop of the eyepins.
- Add 2 beads to eyepin and create a loop with round nose pliers, attach to the bottom split ring.
- Add 1 bead to each headpin & create a loop on top of the bead.
- Gently open loop to the side, slip onto split ring and close. (2 beads per ring)
- Continue adding beads until the split rings are filled.
Remember: this project works best with large, heavy beads and charms.
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ladyjspice 2198779
Dec 02, 2010
This is a great idea that can be used anytime of the year. Just a few color changes for the holiday or picnic theme. Thanks so much.
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Feb 22, 2010
this is really wonderful...i love this idea.
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Feb 20, 2010
I just love this idea...I can't wait to get started making a set for our table.
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Feb 19, 2010
These look like they would work great to hold down table cloths when eating outdoors too.
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Jolina Jolie Model
Vena PhotographyPhotographer Female Miami, Florida, US My MM URL: http://www.modelmayhem.com/venareiziss
Mayhem # 3035622
About MeMy name is Vena Reiziss.I use to work as a TV host and reporter. While working in these exciting fields, I learned how to capture emotion and character in the special moments happening around me. Photography is one of my true passions.I usually shoot wedding, family,couple,etc,but I love to shoot models as my free time.I DO NOT shoot nude!
Please inbox me if you would like to work together. IM IN FL AND MIAMI ONLY!
More info go to my Facebook: Vena Kittiwongwanit
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Broncos routed by Rhinos
McGuire scores four tries as Leeds claim third straight win
Last Updated: 30/06/12 5:45pm
Danny McGuire: Scored four of the Rhinos' 10 tries
Danny McGuire scored four tries as Leeds continued their Stobart Super League recovery with a 58-12 thrashing of London Broncos at the Stoop.
The Rhinos ran in a total of 10 tries, six coming in the final 20 minutes, as the Broncos fell way short in their bid to record back-to-back home wins.
Leeds have now secured three straight wins to recover from their poor run of form in May and the early part of June, strengthening their push for a play-off place in the process.
The defending Super League champions came under early pressure, however, when Michael Witt engineered a gap for Dan Sarginson only for the full-back to be hauled down just short of the line.
Leeds had a try chalked off for an obvious forward pass but it was the Broncos who were having the bulk of the play, Scott Wheeldon coming close to giving the hosts the lead only to spill a pass near the Rhinos line.
A surging run Julien Rinaldi then took the hosts deep into Leeds territory and Chris Bailey rounded the move off by storming over at the sticks in the 22nd minute.
The Rhinos were stung into action and responded with a try of their own moments later as Shaun Lunt crashed over from close range to level things up.
Lunt then pushed Leeds into the lead in the 31st minute, barrelling over under the posts after bursting through some increasingly tired Broncos tackling.
By the half-time break the Rhinos stretched well clear, McGuire strolling over for a brace of tries on 37 and 39 minutes.
After the break the hosts took advantage of a wayward pass from Zak Hardaker, with Kieran Dixon having the simplest of tasks of picking up possession and cantering over.
London remained two scores behind, although they almost reduced the deficit in the 54th minute when David Howell was unable to hold what would have been a try-scoring pass from Witt.
Having absorbed the best the home side could throw at them, Carl Ablett ran on the last tackle and stretched clear to tee up McGuire for his hat-trick on the hour mark.
That seemed to knock the fight out of the Broncos and moments later Ablett touched down for a try of his own, which was followed by McGuire's fourth.
Further late scores were to follow from Hardaker, Rob Burrow and Kylie Leuluai as the Broncos were powerless to stop the away side in the closing stages.
First Utility Super League
Tue 30th Jun
Hull K R34 - 28Salford Red Devils
Wed 1st Jul
Wakefield Wildcats26 - 16Hull FC
Thu 2nd Jul
Warrington Wolves17 - 6Wigan Warriors
Fri 3rd Jul
Leeds Rhinos46 - 18St Helens
Sun 5th Jul
Huddersfield Giants0 - 0Hull K R
Hull FC0 - 0Wakefield Wildcats
Salford Red Devils0 - 0Catalans Dragons
Castleford Tigers0 - 0Widnes Vikings
Thu 9th Jul
Wigan WarriorsvsLeeds Rhinos
Fri 10th Jul
St HelensvsHuddersfield Giants
Sun 12th Jul
Hull FC0 - 0Castleford Tigers
Salford Red Devils0 - 0Hull K R
Wakefield Wildcats0 - 0Warrington Wolves
Widnes Vikings0 - 0Catalans Dragons
Thu 16th Jul
Warrington WolvesvsSt Helens
Fri 17th Jul
Hull K RvsHull FC
Leeds Rhinos0 - 0Salford Red Devils
Wigan Warriors0 - 0Widnes Vikings
Sat 18th Jul
Catalans DragonsvsHuddersfield Giants
Sun 19th Jul
Wakefield Wildcats0 - 0Castleford Tigers
Thu 23rd Jul
Hull FCvsWigan Warriors
Fri 24th Jul
St Helens0 - 0Hull K R
Sun 26th Jul
Huddersfield Giants0 - 0Wakefield Wildcats
Leeds Rhinos0 - 0Catalans Dragons
Widnes Vikings0 - 0Salford Red Devils
Castleford Tigers0 - 0Warrington Wolves


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Explosia Lyric Video
Photography and Concept By Mario Duplantier
September 07 2012
Interview with Joe at the Heavy MTL - Montreal Canada
Joe was interviewed by Mitch Lafon of PureGrainAudio at the Heavy MTL festival in Montreal earlier this month; the video is above. He talks about breaking into the metal scene from France; getting early support from Lamb of God in…
August 24 2012
New Merch in Stores!
2 new shirts available! Visit our stores!
August 21 2012
Gojira's band members do NOT have any FACEBOOK account! All those "Mario Duplantier", "Joe Duplantier", "Michel Labadie", "Christian Andreu" accounts you can find on Facebook are fake profiles and the persons running them do not have any relationship with the…
August 18 2012
New Tour Dates!
Gojira were planning to spend their late summer days touring with Lamb of God and Dethklok. In light of the tour's cancelation, the band has booked a spate of intimate gigs sprinkled along the East Coast, as well as few…
August 12 2012


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Daniel Doctoroff
Fabulosity, Lawyerly Lairs, Money, Politics, Real Estate
Lawyerly Lairs: A Prominent Chicago Law Grad Sells His $11 Million Townhouse
You'll feel pangs of envy when you find out how much he paid for it….
9/11, Barack Obama, Bloomberg, Books, Guantanamo Bay, Military / Military Law, Politics, Trials, Videos, War on Terror
Is It Time To Close Guantanamo Bay?
One retired admiral thinks so, and a new book by a Wall Street Journal reporter provides supporting evidence.
Kinney's Evan Jowers Now Permanently Based In Hong Kong
After a decade of 60+ trips to Hong Kong from his former Miami home, our Evan Jowers has finally taken the plunge and moved to Hong Kong on a permanent basis. Since '06, Evan has been head of Kinney's Asia recruiting and over that time Kinney has easily placed more US associates, counsels and partners at top tier US and UK firms than any other recruiting firm (we have also made many in-house placements). (…)


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Ghost Tour
First tour at 5:45 p.m, second tour at 7 p.m. Fri, Oct 11, 2013
Venue: The Mount
2 Plunkett St., Lenox, MA 01240Contact:
0 people saved this
It starts with creaking floors, slamming doors, and ghostly footsteps. Come take a 90-minute guided tour of the most haunted parts of the estate. This spooky tour is not recommended for children under 12. Price: Adults $22; 12-18 years $18. For tickets, please call 413-551-5100.
RambleWild: Getting Wild in the Berkshires This Summer
From gleaming waterfalls to majestic panoramic views there's never any shortage of ways to...
Search All Listings Here.


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