Long-term Survival After An Aggressive Surgical Approach in Patients With Breast Cancer Hepatic Metastases

Background: Metastatic breast cancer is generally believed to be associated with a poor prognosis. Therapeutic advances over the past two decades, however, have resulted in improved outcomes for selected patients with limited metastatic disease. Methods: Between March 1991 and October 2002, 31 patients had hepatic resection for breast cancer metastases limited to the liver. Clinical and pathologic data were collected prospectively from breast and hepatobiliary databases. Results: Median age of patients was 46 years (range, 31 to 70). Liver metastases were solitary in 20 patients and multiple in 11 patients. Median size of the largest liver metastasis was 2.9 cm (range, 1 to 8). Major liver resections (three or more segments resected) were performed in 14 patients, whereas minor resections (fewer than three segments resected) with or without radiofrequency ablation (RFA) were performed in 17 patients. No postoperative mortality occurred. Of the 31 patients, 27 (87%) received either preoperative or postoperative systemic therapy as treatment for metastatic disease. The median survival was 63 months; a single patient died within 12 months of hepatic resection. The overall 2- and 5-year survival rates were 86% and 61%, respectively, whereas the 2- and 5-year disease-free survival rates were 39% and 31%, respectively. No treatment- or patient-specific variables were found to correlate with survival rates. Conclusions: In selected patients with liver metastases from breast cancer, an aggressive surgical approach is associated with favorable long-term survival. Hepatic resection should be considered a component of multimodality treatment of breast cancer in these patients.     

A study of the metabolites of ischemia-reperfusion injury and selected amino acids in the liver using microdialysis during transplantation

BACKGROUND: Preservation and ischemia-reperfusion injury still impact the outcome of orthotopic liver transplantation. The authors used microdialysis with a view to monitoring its effect on graft function. METHODS: A microdialysis catheter was inserted into the graft immediately after reperfusion and perfused with an isotonic solution for 48 hr. Metabolites of the ischemia-reperfusion injury and selected amino acids were studied. There were 18 patients, with a median age of 52 years (range, 38-62 years), 8 of whom were men. Lactate, pyruvate, glycerol, and glucose levels were measured. In addition, alanine, arginine, citrulline, gamma-aminobutyric acid (GABA), glutamate, glutamine, glycine, and taurine were determined. RESULTS: All grafts functioned well. High lactate, pyruvate, and glycerol levels were observed in the immediate postoperative period. These showed a significant rapid decrease and stabilized to baseline levels. Alanine, glutamate, GABA, and taurine levels declined significantly to baseline values. Arginine levels were low immediately postreperfusion and then increased, reaching significantly higher values beyond 19 hr. CONCLUSIONS: These data may represent "normal" changes seen in the immediate posttransplant period because all grafts functioned well. Two important metabolic fates of arginine in the liver are in the detoxification of ammonia by means of the urea cycle, and in the synthesis of nitric oxide (NO). Low extracellular arginine may reflect influx of the amino acid into hepatocytes, resulting in formation of NO in the presence of inducible NO synthase or conversion to ornithine in the presence of arginase in the urea cycle. As the organ stabilizes, restriction of arginine uptake may give rise to the observed increase in extracellular arginine.     

The correlation of axillary ultrasonography with histologic breast cancer downstaging after induction chemotherapy

BACKGROUND: The goal of this study was to examine the role of ultrasonography in detecting axillary lymph node metastases in stage II breast cancer patients after induction chemotherapy (IC). METHODS: Of 172 consecutive patients with T1-3, N0-1, M0 breast cancer registered in a prospective IC trial, a subset of 130 evaluable patients were chosen, with (1) both physical and ultrasonographic examinations of the axilla before and after IC; (2) exactly four cycles of IC; (3) no presurgical radiation therapy; and (4) an axillary lymph node dissection. RESULTS: Before IC, 32 patients (25%) were negative for axillary involvement by both physical and ultrasonographic examinations. After IC, this number increased to 64 (49%). Of these, 31 (48%) were positive by pathology examination. In most cases, however, the residual tumor was minimal. CONCLUSIONS: Stage II breast cancer patients who were or became node negative by both ultrasonographic and physical examinations after IC had a 48% incidence of nodal metastases. Because the residual tumor was minimal, irradiation may be sufficient for adequate local control of the axilla.     

Disappearance of Female Genital Mutilation from the Bedouin Population of Southern Israel

IntroductionRecently, clinicians in Southern Israel perceived that the practice of female genital mutilation had disappeared entirely in the Bedouin population. We previously studied the prevalence of this practice in 1995.AimWe decided to survey again the Bedouin population focusing on those tribes previously reported to perform this practice.MethodsEighty percent of the interviews were done by an Arabic-speaking psychiatrist and 20% were done by an Arabic speaking nurse in the gynecologic clinic of a large Bedouin township or the gynecologic clinic of a smaller Bedouin township. Women were asked if they would be willing to answer a few questions about their past and if they were willing to have the gynecologist, with no additional procedure, note whether any operation had been performed on their genitalia.Main Outcome MeasuresPhysical examination by gynecologist and an oral questionnaire.ResultsOne hundred and thirty two women were examined. No cases of any scarring of the kind reported in the previous study were found on physical examination.ConclusionsFGM has apparently disappeared over 15 years in a population in which it was once prevalent. Halila S, Belmaker RH, Rabia YA, Froimovici M, and Applebaum J. Disappearance of female genital mutilation from the bedouin population of Southern Israel. J Sex Med 2009;6:70–73.     

Laryngeal Mass with Multiple Cranial Neuropathies as a Presenting Sign for Varicella Zoster Infection

The most common presentation of varicella zoster virus (VZV) infection is unilateral distribution of herpetic eruptions and neuralgia. Laryngeal involvement is considered very rare.     

Index Radial Collateral Ligament Repair with Titanium Mini-Suture Anchor: Osteolysis Complication of an Underreported Injury

We are reporting on a case of an index radial collateral ligament tear repaired with a titanium Mitek bone suture anchor. The development of cystic radiographic changes and increased pain and weakness led to suture anchor removal at 10 months post-repair. Periprosthetic osteolysis due to titanium-induced osteoclastogenesis and micromotion was suspected to be the cause. This case report provides a dual focus by stressing the importance of the diagnosis and treatment of this underreported ligament tear and highlighting our osteolysis complication via the mechanism of titanium-induced osteoclastogenesis for future therapeutic preventive measures.