Breast cancer--22nd annual symposium. 8-11 December 1999, San Antonio, TX, USA

This symposium focused on trials conducted primarily on patients with metastatic breast cancer with the aim of defining the safest and most effective treatment regimens. The combination of paclitaxel and doxorubicin procured a survival advantage, though confirmation of this multicenter randomized data is awaited from other studies. In elucidating the most effective agents to use with trastuzumab (Herceptin; Genentech Inc), results with vinorelbine (Navelbine; Pierre Fabre SA) were most encouraging. Randomized studies of hormonal agents in the adjuvant setting have demonstrated an improved relapse-free survival with goserelin (Zoladex) and anastrozole (Arimidex; both AstraZeneca plc), compared to tamoxifen. Data were presented suggesting tamoxifen leads to a worse outcome when prescribed to pre-menopausal estrogen-receptor negative patients. The use of newer selective estrogen receptor modulators (SERMs) was discussed with particular reference to LY-353381 (Eli Lilly and Co) and fulvestrant (AstraZeneca plc), both of which appear to have impressive profiles of action when compared to tamoxifen.

Secondary amyloidosis associated with giant cell arteritis/polymyalgia rheumatica

Although giant cell arteritis (GCA) is characterized by chronic inflammation, secondary (AA) amyloidosis appears to be an exceptionally rare complication of this disorder. We describe an 84-year-old man with biopsy proven GCA and polymyalgia rheumatica (PMR) who was found at autopsy to have AA amyloid deposition in numerous organs, 9 years after his diagnosis of GCA. Persistent musculoskeletal symptoms, attributed to refractory PMR during the patient's life, were likely due to AA amyloidosis. This unrecognized complication of GCA/PMR confounded his therapy, leading to excessive treatment with corticosteroids and methotrexate. This case shows that the occurrence of AA amyloidosis should be considered in patients with "refractory PMR" developing after a period of treatment, and that autopsies play a vital role in enigmatic cases.

Ascites and apparent renal failure treated with a Foley catheter

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Pulmonary manifestations of ulcerative colitis mimicking Wegener's granulomatosis

We describe 2 patients with quiescent ulcerative colitis who developed clinical syndromes suggesting Wegener's granulomatosis. Both patients had features of systemic illnesses, nodular lung lesions, and antineutrophil cytoplasmic antibodies. Although the inflammatory bowel disease of both patients was quiescent at the time of their pulmonary presentations, lung biopsy results were consistent with pulmonary complications of ulcerative colitis, an unusual manifestation of that disorder. These cases illustrate that pathological confirmation of the diagnosis is essential in cases of suspected vasculitis. The patients' pulmonary lesions resolved promptly after treatment with corticosteroids.

Studs, the Ordernet and peer review

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