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PubMed2005

Anti-hu paraneoplastic syndrome presenting as bilateral sixth cranial nerve palsies.

A 62-year-old woman presented with diplopia caused by bilateral sixth cranial nerve palsies. Two weeks later, she had bulbar weakness and ataxia. Brain magnetic resonance imaging showed non-specific abnormalities and spinal fluid was acellular but contained an elevated protein and oligoclonal bands. A paraneoplastic screen showed anti-Hu antibodies. Her clinical condition improved with immunoglobulin and systemic corticosteroid treatment. Breast cancer was diagnosed 21 months later by mammography but there were no metastases detected. Four and half years after the onset of her diplopia, she died of diffuse metastatic breast cancer. This is the first reported case of anti-Hu paraneoplastic brain stem encephalitis presenting with sixth cranial nerve palsies.

Abducens Nerve Diseases↗
PubMedDate not supplied

Total mastectomy under local anesthesia: the tumescent technique.

The management of breast cancer in elderly women is controversial. Breast cancer in this age group tends to be biologically less aggressive and is highly responsive to hormonal intervention. The risk of dying of other causes often exceeds the risk of cancer recurrence. For these reasons, older patients tend to be treated less aggressively. One large study of elderly women with breast cancer found that half of the patients were undertreated. Four patients (mean age 72 years, range 61-95 years) underwent a unilateral total mastectomy for cancer under local anesthesia using the tumescent technique of infiltrating dilute lidocaine with epinephrine (25 ml of 1% lidocaine [250 mg] and 1 ml of 1:1000 epinephrine [1 mg] to 1 L of Ringers lactate) via an infusion pump. Three of the patients had estrogen receptor (ER)-negative tumors and one patient had tumor progression despite switching from tamoxifen to anastrozole. All four patients were class IV as defined by the American Society of Anesthesiology (ASA). There was no morbidity related to the surgery in the form of hematoma, wound infection, or skin flap necrosis. The patients were discharged 1-4 days after surgery. The anesthesia was adequate in all four cases and there was no deviation from the described technique. The mean operative time was 35 minutes (range 24-46 minutes). The tumescent technique is a safe, effective method for performing a total mastectomy in patients who would not be considered candidates for general anesthesia.

Aged↗
PubMed1992

Intravenous or oral adjuvant CMF for node-positive breast cancer.

To assess the optimal duration and method of administration of adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy, 116 patients with positive axillary nodes after total mastectomy and axillary dissection were reviewed retrospectively. CMF was administered in three progressively shorter regimens, which consisted of oral CMF for either 12 or six cycles and intravenous (i.v.) CMF for six cycles. Median follow-up for surviving patients was 62 months. The three groups were matched for major prognostic factors. There was no advantage in using more than six cycles of adjuvant CMF. There was an improved crude 3 year disease-free survival (84 vs 65%, P = 0.05) and a trend towards improved overall survival (92 vs 85%, P = NS) in patients treated with six cycles of oral CMF compared with i.v. CMF. Survival rates were not significantly different beyond 3 years. Leucopenia and alopecia were more severe with oral CMF (P less than 0.01), and compliance worse with oral CMF x 12 (P = 0.01). Since the data suggest that i.v. CMF is at least as equal as oral CMF a randomized controlled trial should be undertaken.

Adjuvants, Pharmaceutic↗
PubMed1995

Locally advanced breast cancer: is surgery warranted following chemotherapy?

Various methods of management of locally advanced breast cancer have been proposed, including combinations of chemotherapy, surgery, radiotherapy, immunotherapy and hormone manipulation. This retrospective study evaluated the effectiveness of chemotherapy in the management of locally advanced breast cancer in pre- and perimenopausal women by examining the pathology of the mastectomy specimens. Sixteen women who on initial clinical examination had breast cancers measuring 5 cm or greater underwent chemotherapy prior to surgery. Four women were also treated with radiotherapy prior to surgery. All 16 women underwent mastectomy and axillary clearance. All specimens showed residual tumour in the mastectomy specimen or the regional lymph nodes. Chemotherapy is useful in reducing tumour burden to allow surgical resection, but does not produce centripetal shrinkage of tumour, nor sterilize the breast of cancer. In this small series, the addition of radiotherapy also failed to clear the patient of tumour. Wide surgical excision including the original tumour margins is thus required to achieve locoregional control. Until chemotherapy and radiotherapy regimens can be proved to sterilize the breast of tumour, we caution against the use of any surgery less than total mastectomy if optimal local control is to be achieved for locally advanced breast cancer in pre- and perimenopausal women.

Adult↗
PubMed1996

Paraffinomas of the breast: an oriental curiosity.

BACKGROUND: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30-40 years ago. Patients may present many years later with complications of this treatment. METHODS: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3-41 years (median 17) previously. RESULTS: Patients presented with hard masses in the breast 4-18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes. CONCLUSIONS: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually require total mastectomy.

Adult↗
PubMed1997

Surgical treatment of breast cancer in New South Wales 1991, 1992.

BACKGROUND: The purpose of this study was to examine existing data on women diagnosed with breast cancer in New South Wales in 1991 and 1992 and to describe surgical treatments received on an inpatient basis. METHODS: Analyses were based on the linkage of two databases: the New South Wales Central Cancer Registry and the New South Wales Health Department's Inpatient Statistics Collection. Data were limited to women who were resident and treated in New South Wales. Main analyses were restricted to definitive surgical procedures. RESULTS: Thirty-six per cent of women treated surgically for breast cancer in 1991 had breast-conserving therapy. This had increased to 39% in 1992. There were substantial geographical variations in the use of breast-conserving therapy in New South Wales which could not be explained by patient characteristics. Age, degree of spread at diagnosis, and area health service/ health region were all found to have an independent association with the probability of having a mastectomy. CONCLUSIONS: Women with a localized degree of spread living in non-metropolitan areas (Health Regions) were almost twice as likely to have a mastectomy as compared with similar women who were resident in metropolitan areas (Area Health Services). The concentration of radiotherapy services may have contributed to the urban/rural variation in breast-conserving therapy in New South Wales, but it is also likely that some of the variations that were observed may be a reflection of the failure of clinicians to use best current practice.

Adult↗
PubMed1993

Basal cell carcinoma of the male nipple. Case report and review of the literature.

BACKGROUND: Basal cell carcinoma (BCC) of the nipple is a very unusual occurrence, often mistaken for Paget's disease. OBJECTIVE: By reporting a further case of BCC of the nipple in a 57-year-old man and by reviewing the sixteen previously reported cases, we mean to characterize further a common lesion arising at an unusual site. We also wish to stress the lack of agreement regarding the treatment of BCC of the nipple. METHODS: Review of the literature was based on a search in Medline. CONCLUSIONS: We appeal to compile all cases of BCC arising at unusual locations in order to gain a better understanding of these lesions.

Biopsy↗
PubMed1994

Starling pressures in the human arm and their alteration in postmastectomy oedema.

1. Surgery and radiotherapy to axillary lymph nodes during breast cancer treatment is often followed, commonly years later, by chronic postmastectomy oedema (PMO). PMO is considered a 'high protein' oedema due to reduced axillary lymph drainage. Since oedema formation also depends on fluid input (capillary filtration), we studied the Starling pressures in the affected and contralateral arm. Colloid osmotic pressure was measured in patient serum (pi p) and interstitial fluid (pi i). Subcutis fluid was collected from PMO arms by both wick and aspiration methods, and from the control arm by the wick method only. Interstitial hydraulic pressure (P(i)) was measured by the wick-in-needle method. 2. Oedema pi i was 19.2 +/- 4.1 cmH2O (n = 13, wick) to 16.3 +/- 4.4 cmH2O (n = 41, aspirate; difference not significant; mean +/- S.D. throughout). This was significantly lower than pi i in the control arm (21.4 +/- 3.8 cmH2O, n = 14, P < 0.01, analysis of variance). Also, there was a negative correlation between oedema pi i and the percentage increase in arm volume (correlation coefficient r = -0.35, P < 0.05) in contrast to conventional expectation. 3. Oedema P(i) (1.9 +/- 2.0 cmH2O, n = 28) exceeded the subatmospheric control P(i) (-2.8 +/- 3.0 cmH2O; P < 0.01). Venous and arterial pressures were normal but pi p was subnormal (31.1 +/- 2.7 cmH2O, n = 47). 4. Net pressure opposing capillary blood pressure, P(o), was calculated as P(i) + sigma (pi p-pi i) for a reflection coefficient, sigma, of 0.90-0.99.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Mastectomy or conservation: the patient's choice.

STUDY OBJECTIVE: To determine whether, if given the choice, patients with breast cancer would prefer mastectomy or conservation treatment, neither treatment having been shown to be preferable. DESIGN: Non-randomised case series with 28 patients interviewed after two years and all followed up. SETTING: Secondary care referral centre. PATIENTS: 153 women, aged less than 65, with T1, T2, N1, and N0 tumours of the breast given the choice of treatment (that is, all eligible patients from December 1979). INTERVENTIONS: Patients were asked, after information and counselling, which treatment they would prefer. The chosen treatment was given without further question. Mastectomy included node sampling and local radiotherapy if indicated. Conservation treatment comprised excision of the lump, external radiotherapy, and irridium wire implant to tumour bed. MAIN RESULTS: Conservation treatment was chosen by 54 women and mastectomy by 99. Reasons for preferring mastectomy included desire for rapid treatment for domestic or employment reasons and fear of possibility of future mastectomy. Only two of the sample interviewed regretted their choice. During limited follow up no advantages to either form of treatment were seen in terms of recurrence or survival. CONCLUSIONS: Patients with breast cancer are capable of choosing treatment and should play a part in deciding which treatment to have. They do not automatically choose to retain the breast.

Adult↗
PubMed1992

Breast conservation therapy in patients with mammographically undetected breast cancer.

The authors reviewed their experience with 542 patients with breast cancer who were treated with conservative surgery and radiation therapy (CSRT) and analyzed the outcome in those patients whose tumors could not be detected with mammography. Fifty-five of the patients (10.1%) had a palpable, pathologically confirmed breast carcinoma and a negative preoperative mammogram. Routine follow-up included annual mammography and physical examination. The local recurrence, 5-year actuarial survival, and 5-year disease-free survival rates for these 55 patients did not differ significantly from those for patients with positive mammograms. There were six cases of local breast recurrence in this subgroup. Four of five cases were visible on mammograms (one patient did not undergo mammography at the time of recurrence); two of the cases were detected with mammography alone following physical examination with negative results. The authors conclude that patients with palpable but mammographically occult early-stage breast cancer are suitable candidates for CSRT and that mammography is a mandatory part of follow-up of conservatively treated patients.

Actuarial Analysis↗
PubMed2002

Hereditary premenopausal breast cancer.

Less than 1% of breast cancers occur between the age of 20 and 30 years, but more than 50% of breast cancers under the age of 30 years are hereditary. Breast cancer mainly occurs sporadically, however, in 5 to maximally 10% of cases a genetic predisposition is present. Mutations in the already sequenced tumor suppressor genes BRCA1 and BRCA2 account for 60-70% of these hereditary breast cancers. The chromosomal location of BRCA1 is 17q21 and that of BRCA2 is 13q12-13. Screening procedures and possible prevention strategies for women with mutations in the BRCA1 and BRCA2 genes are discussed. They include the use of tamoxifen.

Adult↗