Intraoperative radiotherapy (IORT) in prostatic cancer

Between February 1982 and February 1986, 30 patients with prostatic cancer received intraoperative radiotherapy (IORT). First 10 cases were treated by the transperineal approach, and after April 1983, 20 cases were done by the retropubic approach. We chose the retropubic approach, because it has advantages over the transperineal approach, which has a risk of rectal damage, lymph-adenectomy can not be performed and the patient can not sit down for a long time after the operation. In the IORT procedure for prostatic cancer by the retropubic approach, a longitudinal lower abdominal incision is made, and pushing down the bladder, the treatment cone is inserted to the prostate. We performed lymph-adenectomy at the same operation, if hard and large lymph-nodes were touched. Of 30 patients, 2 had stage B disease, 10 had stage C and 18 had stage D disease. The overall 5-year survival rate (Kaplan-Meier method) after IORT was 42.6% where as that the 31 cases seen (stage C: 6 cases, stage D: 25 cases) since the Center was founded (October 1975) until the introduction of IORT was 3.2%. Although no definite conclusion can be drawn because all cases received multidisciplinary therapy, IORT appears useful for the treatment of carcinoma of the prostate.     

Exposure to hydrogen sulphide and respiratory function

A study was carried out to assess possible effects of low concentrations of hydrogen sulphide on respiratory function. The cohort comprised 26 male pulp mill workers (mean age 40.3, range 22-60 years) with a daily exposure to hydrogen sulphide in the workplace, and 10 volunteers, who had asthma (three men, mean age 40.7, range 33 to 50 years, and seven women, mean age 44.1, range 31 to 61 years). The respiratory function of the pulp mill workers was monitored by measuring forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and bronchial responsiveness after at least one day off work and at the end of a workday. Bronchial responsiveness was tested by challenge with histamine. The 10 asthmatic subjects were exposed in laboratory conditions to 2 ppm of hydrogen sulphide for 30 minutes in an exposure chamber. Airway resistance (Raw) and specific airway conductance (SGaw) were assessed by a body plethysmograph, and the ventilatory capacities were measured with a flow volume spirometer. No significant changes in respiratory function or bronchial responsiveness related to exposure to hydrogen sulphide in the pulp mill workers were found. In the asthmatic subjects, Raw was increased by 26.3% and SGaw was decreased by 8.4% on average after exposure to hydrogen sulphide. These changes were not statistically significant. In two subjects, however, changes were greater than 30% in both Raw and SGaw, indicating bronchial obstruction. It is concluded that exposure for a relatively short time to hydrogen sulphide concentrations appreciably higher than those existing in ambient air do not cause noticeable effects on respiratory function.     

Changes in bone markers in children with asthma during inhaled budesonide and nedocromil treatments

We evaluated serum and urinary markers of bone turnover in 14 children with asthma during inhaled budesonide and nedocromil treatments. Both the markers of formation (serum carboxy- and aminoterminal propeptides of type I procollagen and serum osteocalcin) and the markers of degradation (serum carboxy-terminal telopeptide of type I collagen and urinary pyridinium cross-links) decreased (p < 0.05) during budesonide treatment for 6 months. During inhaled nedocromil treatment (for the following 6 months), the markers returned to the normal levels. These transient decreases in the markers of both formation and degradation of bone suggest that inhaled budesonide may slightly decrease the bone turnover rate. However, normal “coupling” between formation and degradation seemed to operate, e.g. a change in one resulted in a corresponding change in the other, so that net bone loss did not necessarily occur.     

Cutaneous embryonal rhabdomyosarcoma presenting as a nodule on cheek; a case report and review of literature

We report a case of primary cutaneous rhabdomyosarcoma, solid embryonal type, presenting as a rapidly enlarging nodule on the right cheek of a 7-year-old boy. This lesion had begun as a pea-sized nodule 8 months previously, and, with suspected abscess, had been incised. It recurred 2 months later; at that time, incisional biopsy was consistent with malignant round cell tumor. Wide local excision of the tumor was then completed. Subsequent immunohistochemical staining with desmin and myoglobin confirmed embryonal rhabdomyosarcoma. The patient underwent radiation therapy followed by chemotherapy and continues to be disease free at 14 months after his wide local excision. Rhabdomyosarcoma presenting as a dermal nodule is rare. It usually presents as an asymptomatic papule without distinctive clinical features and therefore may result in delayed diagnosis unless a biopsy is performed.     

Pregnancy after breast cancer: a case study resolving the reproductive challenge with a gestational surrogate

Abstract: Pregnancy and fertility issues are substantial concerns for the young breast cancer survivor, yet the available literature is hampered by a lack of prospective clinical studies and meaningful long‐term outcome data. A lack of reliable information often leads to physician discomfort and patients may be left to navigate the world of fertility preservation and reproductive technology on their own. This case exemplifies some of the many issues that breast cancer survivors may face and adds another dimension to the survivor's dilemma; once fertility options have been preserved, what is the best method to sustain the pregnancy—self or surrogate? For many, the goal of balancing optimal treatment and long‐term survival with restoration of a complete quality of life, including childbearing, may be attainable. This discussion highlights the importance of offering young breast cancer patients an opportunity to discuss these issues with their health care providers prior to initiating therapy.     

Post-traumatic fatal <Emphasis Type="Italic">Nattrassia mangiferae</Emphasis> orbital infection

Nattrassia mangiferae orbital infection is a very rare disease that is usually curable. We report the first case of a fatal N. mangiferae orbital infection following a thorn penetration injury in a patient who also had diabetes mellitus, heart failure, and cirrhosis.