Pericardial effusion complicating acute myocardial infarction

The acute fibrinous pericarditis that complicates acute myocardial infarction is usually of no functional significance. Uncommonly, hemorrhagic effusion may compound this process. In the case reported here, the pericardial aspect of acute lateral myocardial infarction dominated the clinical picture, thus posing a diagnostic problem. This phase of the disease stimulates us to place it on record.     

Pericardial effusion requiring pericardiocentesis in a girl with anorexia nervosa

OBJECTIVE: Silent pericardial effusion is frequently observed in patients with anorexia nervosa. The nature of the pericardial fluid could never be established, as pericardiocentesis was ethically unfeasible. METHOD: We describe the case of a girl with anorexia nervosa in whom an initial, clinically irrelevant pericardial effusion increased rapidly, making pericardiocentesis necessary to prevent cardiac tamponade. RESULTS: It was thus possible to exclude the inflammatory or infectious nature of the pericardial fluid, although the pathogenesis of this cardiac alteration remains obscure. CONCLUSION: Echocardiographic examination appears to be strongly advisable in patients with anorexia nervosa.     

负压封闭引流技术在乳腺癌术后重度皮下积液中的应用

目的探讨负压封闭引流技术(VAC)治疗乳腺癌术后重度皮下积液(>30 mL/d)的有效性。 方法选择2012年1月至2016年6月,于四川省医学科学院·四川省人民医院城东病区确诊为乳腺癌术后重度皮下积液的57例患者为研究对象。按照随机数字表法,将其随机分为VAC组(n＝30,采用VAC治疗)与对照组(n＝30,采用常规引流法治疗)。采取回顾性分析方法,收集2组重度皮下积液患者接受不同引流法治疗的临床愈合时间、引流量及引流时间,并采用成组t检验,对2组上述指标进行统计学比较。VAC组与对照组患者的年龄、乳腺癌手术方式与切口选择、肿瘤临床分期、组织病理学类型、治疗前平均积液量、人体质量指数等基本临床资料比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合病例收集医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试者知情同意,并与之签署临床研究知情同意书。 结果VAC组患者的平均愈合时间为(15.7±4.4) d,显著短于对照组的(33.2 d±3.7) d,2组比较,差异有统计学意义(t＝8.362,P＝0.004)。VAC组平均引流时间为(6.2±3.5)d,显著短于对照组的(25.8±5.0) d,2组比较,差异有统计学意义(t＝11.293,P<0.001)。VAC组平均引流量为(283.5±2.8) mL,显著少于对照组的(369.4±3.4) mL,2组比较,差异亦有统计学意义(t＝9.472,P＝0.016)。 结论VAC治疗乳腺癌术后重度皮下积液,较目前临床所用的常规引流法,具有降低乳腺癌术后引流量,缩短治疗时间及引流时间的疗效。但是,VAC是否值得于乳腺癌术后重度皮下积液患者中推广、应用,则尚需大样本、多中心随机对照试验,进一步研究、证实。     

Milky-white pleural effusion complicating peripherically inserted central venous catheter for total parenteral nutrition

Pleural effusion secondary to vascular perforation and leakage of total parenteral nutrition (TPN) is a rare complication of central lines. We report such a case and urge physicians to familiarize with recognition and management of this rare complication as both TPN and central catheter lines are widely used techniques.     

Costs of breast cancer and the cost-effectiveness of breast cancer screening.

Breast cancer is the second leading cause of death by cancer among women in the United States. The total cost of illness for breast cancer has been estimated to be $3.8 billion, of which $1.8 billion represents medical care costs. It has been estimated that breast cancer detected early is considerably less expensive than when the tumor is discovered at a later stage. Mass screening using mammography can improve early detection by as much as 15-35%. Cost-effectiveness studies have estimated that the costs of breast cancer screening range between $13,200 and $28,000 per year of life saved. The cost-effectiveness of breast cancer screening in the 40-49-year-old age group is controversial. Mass screening for breast cancer will probably increase total health care costs, but when all economic costs are included, screening appears to be more cost-effective than not screening.     

Lactation and breast cancer risk.

BACKGROUND: Data from the Carolina Breast Cancer Study, a population-based, case-control study of breast cancer in African-American and white women residents of North Carolina, were evaluated to determine whether specific aspects of lactation are associated with a reduction in the risk of breast cancer. METHODS: Analyses included 751 parous cases and 742 parous controls frequency-matched on age and race. Information on lactation, reproductive history, lifestyle characteristics and family history were obtained through a personal interview. RESULTS: When women who breastfed were compared to those who never breastfed, odds ratios and 95% confidence intervals of 0.8 (0.5-1.1) and 0.7 (0.5-0.9) were found for women 20-49 years and 50-74 years, respectively. Similar inverse associations were observed for each of three categories of lifetime duration (1-3, 4-12, 13+ months). The inverse associations persisted and did not vary when number of children breastfed, ages at first and last lactation and lactational amenorrhoea were examined. CONCLUSIONS: Our findings suggest that any lactation, regardless of duration or timing, is associated with a slight reduction in the risk of breast cancer among younger and older parous women.     

Cigarette smoking and breast cancer.

An epidemiological case-control study was conducted in New York State, with 1617 primary breast cancer patients and an equal number of controls, to examine the relationship between cigarette smoking and breast cancer. Results showed no overall association between ever smokers versus never smokers and breast cancer risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 0.90-1.19), nor was there any dose response trend observed with increased levels of smoking. In addition, no association was found with risk and age started smoking, age stopped smoking, amount smoked or total years smoked. Controlling for previously identified risk factors for breast cancer in the analysis did not significantly alter these relationships. Previous studies have found a difference in menopausal age among smokers compared to nonsmokers. The mean menopausal age was only slightly lower in smokers than in never smokers for both cases and controls. Breast cancer risk was observed to be close to unity for premenopausal women (OR = 0.97, 95% CI: 0.74-1.34) and postmenopausal women (OR = 1.06, 95% CI: 0.91-1.26). A recent study suggested breast cancer risk was more strongly related to starting smoking at a young age among women who smoked at least 25 or more cigarettes per day in the most recent year of smoking. This hypothesis was not supported by these data.