Tumor characteristics and patient outcomes are similar between invasive lobular and mixed invasive ductal/lobular breast cancers but differ from pure invasive ductal breast cancers

Background

The aim of this study was to investigate the clinical characteristics associated with invasive lobular cancer (ILC) and mixed invasive ductal cancer (IDC) and ILC compared with IDC.

Methods

From 1996 to 2006, 4,336 patients with IDC, ILC, and mixed breast cancers were identified. Clinical variables were compared using χ² and Fisher's exact tests. Kaplan-Meier survival curves were constructed.

Results

Patients included 3,595 (83%) with IDC, 480 (11%) with ILC, and 261 (6%) with mixed cancers. Patients with ILC and mixed cancers were more likely to have low-grade and estrogen-positive and progesterone-positive tumors but were diagnosed at higher stages of disease compared with patients with IDC (P < .05 for each). Patients with IDC had the poorest 5-year (80%) and 10-year (61%) survival compared with patients with ILC (87% and 68%) and mixed (84% and 69%) cancers (P = .029).

Conclusions

Although patients with ILC and “mixed” cancers are diagnosed with more advanced disease, their survival is superior to patients with IDC.     

Control of malignant melanoma of the nasal mucous membrane

Malignant melanoma of the nasal mucous membrane continues to be a rare disorder which is difficult to treat. Five year survival rate appears to be less than 30% and most patients who die of the disease have distant metastasis. At this time, the otolaryngologist and head and neck surgeon must strive to control local and regional disease with surgical means. Unfortunately, these means are usually inadequate because survival is critically dependent on the biology of the melanoma and its interaction with the patient's immune system.     

Gilbert syndrome increasing unconjugated hyperbilirubinemia in a child with hereditary spherocytosis

Hemolytic anemia usually gives rise to only a modest elevation of serum bilirubin. Unconjugated hyperbilirubinemia of an extreme degree should raise suspicion of additional factors. We describe a 10-year-old child suffering from hereditary spherocytosis, who had unusually high levels of unconjugated serum bilirubin and was diagnosed to have Gilbert syndrome on the basis of genetic analysis.     

Leukocytoclastic vasculitis associated with use of aromatase inhibitors

Leukocytoclastic vasculitis is an uncommon but important complication of aromatase inhibitor use which may have cosmetic and systemic ramifications. We present a case in which this reaction was observed and aim to compare the characteristics of patients and trajectory of disease in order to assist with early identification and treatment.     

Feasibility and efficacy of placement of continuous sciatic perineural catheters solely under ultrasound guidance in children: a descriptive study

Background: Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Method: Forty ASA 1 and 2 patients aged 8 months–10 years posted for congenital talipoequinovarus surgery were included in the study. Continuous sciatic catheters were placed under ultrasound guidance with 18‐ gauge Tuohy needle at the infragluteal fold. Then, 0.25% of bupivacaine 0.5 ml·kg^?1 bolus was injected followed by continuous infusion later. Half the volume of the drug was injected prior to catheter insertion to improve visibility. The sciatic nerve, needle tip and shaft, catheter tip and the drug spread were visualized. The efficacy of the block intraoperatively and postoperatively was evaluated. Results: The sciatic nerve, needle shaft, and tip were well visualized in all 40 patients. The catheter tip was seen in 72.5% of patients. The effect of block was complete intraoperatively and postoperatively. Clinically significant complications were absent. Conclusion: We conclude that in children, continuous sciatic catheters can be accurately and efficaciously placed with minimal equipment with ultrasound alone.