Pleural effusion in breast cancer: a review of 105 cases

This paper reviews 105 patients with breast cancer who had a pleural effusion as a direct consequence of metastatic disease. The mean lag time between diagnosis of primary tumor and presentation of the effusion was 41.5 months. Mean survival time after development of an effusion was 15.7 months. Of the 99 patients with unilateral breast tumors, 50% had ipsilateral effusions, 40% were contralateral, and 10% were bilateral. Forty-two percent of the patients had pleural effusion as the first evidence of recurrence. No particular group of women, based on age, menopausal status, or parity could be identified as being at risk of developing a subsequent effusion. However, there was a significantly higher proportion of patients who had central and medial tumors and who had Stage III cancers. Other tumor features, such as size, histologic type, or grade, did not predict the development of pleural metastasis. The success rate of a variety of treatment methods, local, general, or a combination of both, was 17% in achieving control of effusions. There may be a place for more aggressive treatment of pleural effusion at first presentation so that the quality of life could be improved during the patient's remaining months of survival.

Evaluation of staining methods for identifying Campylobacter pylori

Campylobacter pylori has been implicated in the pathogenesis of peptide ulcer disease. The rapid identification of this organism may depend upon histologic diagnosis, because culture methods are complex and require a minimum of seven days in order to identify a negative specimen. The purpose of this study was to determine which stain used to identify this organism was the most cost-effective and easiest to perform and interpret on a routine basis. Sixty-one consecutive gastric antral biopsies were stained with hematoxylin and eosin, Giemsa, Brown-Brenn, and Warthin-Starry, with 23 of the cases stained by Brown-Hopps. Of the stains tested, the Wright-Giemsa was the easiest to perform. The organisms on the Wright-Giemsa showed a smooth, uniform purple color, whereas the Warthin-Starry gave the organism a granular appearance that at times could be confused for silver precipitate. Both the Wright-Giemsa and Brown-Hopps stain had the highest degree of identification of the organism (defined by percent positivity). The routine use of the Wright-Giemsa stain for identification of C. pylori in antral biopsies is recommended.

Language disturbance and functioning in first episode psychosis

Language disturbance has a central role in the presentation of psychotic disorders however its relationship with functioning requires further clarification, particularly in first episode psychosis (FEP). Both language disturbance and functioning can be evaluated with clinician-rated and performance-based measures. We aimed to investigate the concurrent association between clinician-rated and performance-based measures of language disturbance and functioning in FEP. We assessed 108 individuals presenting to an Early Intervention in Psychosis Service in Ireland. Formal thought disorder (FTD) dimensions and bizarre idiosyncratic thinking (BIT) were rated with structured assessment tools. Functioning was evaluated with a performance-based instrument, a clinician-rated measure and indicators of real-world functioning. The disorganisation dimension of FTD was significantly associated with clinician-rated measures of occupational and social functioning (Beta=-0.19, P<0.05 and Beta=-0.31, P<0.01, respectively). BIT was significantly associated with the performance-based measure of functioning (Beta=-0.22, P<0.05). Language disturbance was of less value in predicting real-world measures of functioning. Clinician-rated and performance-based assessments of language disturbance are complementary and each has differential associations with functioning. Communication disorders should be considered as a potential target for intervention in FEP, although further evaluation of the longitudinal relationship between language disturbance and functioning should be undertaken.

Herd composite somatic cell counts: average linear score and weighted average somatic cell count score and milk production

The relationship between herd production weighted average somatic cell count (average of somatic cell count weighted by individual cow milk production) and average linear score (average of individual cow linear score somatic cell counts) was investigated using three models. The model with the highest R2 was log weighted average somatic cell count versus average linear score. Use of the regression model results to convert an average linear score to weighted average somatic cell count results in a bulk tank somatic cell count approximately twice that of conversion of a linear score somatic cell count when done on an individual cow basis. Rolling herd average milk decreased 190 kg as average linear score increased by 1.

Recurrent aneurysmal fibrous histiocytoma

Aneurysmal fibrous histiocytoma is a rare variant of cutaneous fibrous histiocytoma that results from blood vessel proliferation and haemorrhage into a fibrous histiocytoma. The resulting lesion has a very different clinical appearance, hence the potential confusion with other skin lesions. This report describes the case of a 48 year old woman with a recurrent fibrous histiocytoma with prominent vasculature, which over a three year period recurred on two occasions, showing more progressive features of the aneurysmal variant. In addition, squamous lined cysts were present within this tumour, a finding that has not been described previously. The histological features of this rare lesion and the importance of the differential diagnosis from other similar appearing malignant lesions will be discussed.

Is intralesional cidofovir worthwhile in juvenile recurrent respiratory papillomatosis?

OBJECTIVE

To investigate the efficacy of intralesional cidofovir in the treatment of recurrent respiratory papillomatosis (RRP) in children.

METHODS

Prospective observational study of four consecutive children with RRP treated at an academic tertiary children's hospital. Laryngo-bronchoscopy was performed at three- to five-weekly intervals. Photodocumentation was obtained and disease severity assessed using an anatomical RRP severity score. Surgical debulking of large papillomas was then performed, and cidofovir (5 mg/ml) injected into any remaining papillomas as well as submucosally at the sites of resected papillomas. The efficacy of cidofovir was assessed by the change in papilloma severity score over the course of the treatment.

RESULTS

Complete disease remission was obtained in one patient, with a partial response seen in two others. One patient showed no significant response. The greatest beneficial effect was seen after the fourth cidofovir injection; however, two patients demonstrated a deterioration in severity scores after treatment was withheld at this point. Both responded well to further cidofovir injections. However, a clear plateau in the response to cidofovir was seen in all patients by the eighth injection.

CONCLUSION

Intralesional cidofovir may help control papilloma regrowth and reduce disease severity in many children with RRP. In most cases, cidofovir would appear to be less efficacious in causing disease eradication. There appears to be little evidence to support prolonged treatment regimes (i.e. more than eight treatments).

Amputation for acute ischaemia is associated with increased comorbidity and higher amputation level

BACKGROUND

There is some evidence that the early outcome of major amputation is worse after failed thromboembolectomy, but the risk factors and results of amputation done for acute ischaemia have never been compared with those for chronic ischaemia in a large series of patients.

METHOD

Retrospective review of 30 day outcome for all 322 primary amputations done for arterial disease during 1992-8. There were 286 patients (163 male; median age 76 years) who had 270 amputations for chronic ischaemia and 52 for acute ischaemia.

RESULTS

The acute group had higher prevalences of cardiac disease (48% versus 29%-p<0.02), limiting pulmonary disease (27% versus 13%-p<0.02) and ASA grades 4 and 5 (27% versus 14%-p<0.05). Amputation below the knee was less common after acute ischaemia (31% versus 60%-p<0.001). There were trends towards more revisions (19% versus 11%) and higher mortality (25% versus 19%) in the acute group but neither reached statistical significance.

CONCLUSION

Patients having major amputations for acute ischaemia have higher levels of pre-existing comorbidity than those with chronic ischaemia and are twice as likely to require amputation above the knee. They should be managed as a particularly high risk group.

Oestrogen receptors and response to cytotoxic chemotherapy in advanced breast cancer

Of 54 patients with advanced breast cancer, 21/37 (57%) with oestrogen receptor-positive (ER+) tumours and 11/17 (65%) with oestrogen receptor-negative (ER-) tumours responded to cytotoxic chemotherapy. These data and a survey of the literature indicate that oestrogen receptor status is not a determinant of response to chemotherapy. However, ER+ tumours seem to grow more slowly than ER- ones and the response to chemotherapy tends to be longer in ER+ patients.

Anaesthesia and analgesia for major lower limb amputation

This study describes the methods of anaesthesia and analgesia used in 349 major lower limb amputations for vascular disease over a seven year period (1992-8). The main type of anaesthesia was general in 55%, spinal in 29%, and epidural in 14%: there were no significant differences for ASA grade, age, or amputation level, nor any statistical differences in mortality for each method of anaesthesia. The main methods of analgesia in the first 48 hours changed between 1992 and 1998, with decreasing intramuscular and oral opioids (from 38% to 7%, and from 23% to 2% respectively) while epidurals became the commonest method (4% in 1992 and 63% in 1998). Thirty seven percent of patients were prescribed carbamazepine for phantom pain. There have been substantial changes in postoperative analgesia following amputation, and epidurals are now common practice, despite the controversy about their role in preventing phantom pain.

Successful treatment of a chronically infected and necrotic tendo Achillis in a diabetic with excision, flexor hallucis longus transfer and split-skin grafting

Chronic infections and ulceration around the tendo Achillis are difficult to manage. Split-skin grafts do not survive even on healthy exposed tendon. Refractory cases may require plastic surgical intervention with the use of free flaps. Patients with significant vascular disease are not suitable for such techniques. Flexor hallucis longus tendon transfer is an established treatment for chronic ruptures of the tendo Achillis.

We report the successful treatment of an infected tendo Achillis with excision and reconstruction with flexor hallucis longus transfer. The muscle belly of this tendon allowed later skin grafting while the tendon transfer provided good functional recovery.

A Decade after Cairo

The Programme of Action issued by the 1994 UN International Conference on Population and Development was the first and most wide-ranging international policy document to promote the concepts of reproductive rights and reproductive health. Its major recommendation was that population programmes should provide comprehensive reproductive health services integrated and coordinated with each other and with other health services. It put women at its centre and expressly rejected the use of incentives and targets in family planning services. But the Programme of Action is still far from being implemented because health services are declining or have collapsed; the underlying conditions determining women's health and their control over childbearing are deteriorating; fundamentalisms opposing women's rights are on the rise; and neo-Malthusian thinking is as ingrained as ever in development institutions, donor agencies and government departments. These negative forces on women's health can be attributed to the implementation of neo-liberal economic and health policies over the past two decades. The Programme of Action, together with the accompanying political organising by international women's organisations and population groups, did not challenge neo-liberalism sufficiently, but endorsed it in several respects. It thereby undermined its ground-breaking principles and goals of reproductive health.

The response to endocrine therapy in patients with advanced breast cancer in Great Britain and Japan

A prospective study has been carried out to compare the response rates to endocrine therapy of Japanese and British women with breast cancer. Premenopausal women were treated by ovarian ablation, patients who were up to five years postmenopausal were prescribed androgen therapy and patients who were more than five years postmenopausal were treated with oestrogens. No differences in response rate, response time or survival could be detected in the three categories of patients. Significantly more Japanese patients presented with pulmonary metastases in the pre- and postmenopausal groups. In postmenopausal Japanese patients treated with oestrogens, those with pulmonary metastases survived significantly longer.

Sexual Assault in Ethiopian Contexts: Data From a Large Sample of Women and Girls Presenting at Two Hospital-Based, Limited-Resource Sexual Assault Treatment Clinics

This study presents data from a large sample of clinic-evaluated sexual assault survivors ( N = 1,667) in Ethiopia between 2009 and 2015, one of the largest such samples ever analyzed in an African country. Statistical analyses revealed a disproportionate number of minors presenting to the clinics, an extremely high prevalence of special kidnapping cases, significant differences in access and assault characteristics between survivors from within the clinic cities and those from outside of them, and an unacceptable clinical focus on unreliable hymenal findings. In addition, a myriad of important findings regarding patient characteristics, as well as injury and medical outcomes, are reported.

Medium-term mortality after hip fractures and COVID-19: A prospective multi-centre UK study

PURPOSE

The COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3-4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture.

METHODS

A multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for "fragility hip fractures" were included in the study. Patients' 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27.

RESULTS

A total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30- and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% CI 0.865-3.978).

CONCLUSION

Hip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of "long-COVID" and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.

Unaltered metabolism of taurolithocholic acid with changes in composition of rat intestinal microflora

Changes in composition of both total aerobes and anaerobes of rat intestinal microflora do not appear to affect the metabolism of taurolithocholic acid.

A mechanism for improved talc pleurodesis via foam delivery

Talcum powder is recognized as the leading drug for pleurodesis, a treatment of choice for malignant pleural effusions. Recently, it was shown that hydrogel foam delivery systems significantly enhanced the number of adhesions between the chest wall and the lung in a New Zealand rabbit model due to the sol-gel transition. However, many questions still remain regarding the cause of improved efficacy, such as: (1) Would only hydrogel foams improve the efficacy of talc pleurodesis? (2) Is it possible to achieve the same efficacy of hydrogels using non-hydrogel foams? 3) What are the physicochemical properties that can be correlated to the efficacy of talc pleurodesis? In this study, we use non-hydrogel foam formulations to determine the efficacy of pleurodesis. Foam stability and rheology of the formulations were correlated to adhesion formation. The results clearly suggest a correlation of pleurodesis efficacy to the viscosity and modulus of the foam delivery system.