Papillary cystic carcinoma of the pancreas and present status of pancreatic malignancies in Brunei

During the 10-year period from January 1986 to December 1995, a total of six cases of pancreatic carcinoma were documented in Brunei. Among them was a case of papillary cystic carcinoma of the pancreas, in which the patient, a 22-year-old woman, presented with a painless upper abdominal mass that had been increasing in size over a 6-year period. Ultrasonography showed a well circumscribed solid and cystic pancreatic mass. The tumor was excised locally and the patient remained disease-free at 8 months' follow-up. This papillary cystic carcinoma of the pancreas deserves special mention as it has a low-grade malignant potential, is amenable to local resection, and has a good long-term survival rate after excision.     

An unusual finding in a body recovered from the sea

Post-mortem injuries caused by terrestrial and aquatic animals are commonly encountered in forensic practice. We present a case where an autopsy of a body recovered from the sea showed post-mortem injuries and numerous crustaceans in the heart and lungs. They have gained access to these organs via oro–nasal route and subsequent penetration through mediastinal soft tissues and migration down the trachea.     

Impact of visual art on patient behavior in the emergency department waiting room

Background

Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience.

Study Objectives

To analyze the effect of visual art depicting nature (still and video) on patients’ and visitors’ behavior in the ED.

Methods

A pre–post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site.

Results

Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites.

Conclusions

Visual art has positive effects on the ED waiting experience.     

Reliability and validity of arm volume measurements for assessment of lymphedema

BACKGROUND AND PURPOSE: Arm lymphedema following breast cancer surgery is a continuing problem. In this study, we assessed the reliability and validity of circumferential measurements and water displacement for measuring upper-limb volume. SUBJECTS: Participants included subjects who had had breast cancer surgery, including axillary dissection--19 with and 22 without a diagnosis of arm lymphedema--and 25 control subjects. METHODS: Two raters measured each subject by using circumferential tape measurements at specified distances from the fingertips and in relation to anatomic landmarks and by using water displacement. Interrater reliability was calculated by analysis of variance and multilevel modeling. Volumes from circumferential measurements were compared with those from water displacement by use of means and correlation coefficients, respectively. The standard error of measurement, minimum detectable change (MDC), and limits of agreement (LOA) for volumes also were calculated. RESULTS: Arm volumes obtained with these methods had high reliability. Compared with volumes from water displacement, volumes from circumferential measurements had high validity, although these volumes were slightly larger. Expected differences between subjects with and without clinical lymphedema following breast cancer were found. The MDC of volumes or the error associated with a single measure for data based on anatomic landmarks was lower than that based on distance from fingertips. The mean LOA with water displacement were lower for data based on anatomic landmarks than for data based on distance from fingertips. DISCUSSION AND CONCLUSION: Volumes calculated from anatomic landmarks are reliable, valid, and more accurate than those obtained from circumferential measurements based on distance from fingertips.     

Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma

BACKGROUND: Breast conservative surgery (CS) with radiotherapy (RT) is the most commonly used treatment for early-stage breast carcinoma. However, there is controversy regarding the importance of the pathologic margin status on the risk of ipsilateral breast tumor recurrence (IBTR). The current study evaluated the effect of the pathologic margin status on IBTR rates in a cohort of women with lymph node-negative breast carcinoma treated with CS and RT. METHODS: Between August 1980 and December 1994, 452 women with pathologically lymph node-negative breast carcinoma were treated with CS and RT at Westmead Hospital (Westmead, Australia). Central pathology review was performed for all women. The final margins were negative for 352 women (77.9%), positive (invasive and/or in situ) for 42 women (9.3%), and indeterminate for 58 women (12.8%). Information regarding an extensive intraductal component (EIC), lymphovascular invasion, pathologic tumor size, histologic grade, and nuclear grade was available for most women. After macroscopic total excision of the tumor, all women received whole-breast irradiation (usually 45-50.4 grays [Gy]) and the majority of women also received a local tumor bed boost (range, 8-30 Gy). RESULTS: After a median follow-up of 80 months, 34 women (7.5%) developed an IBTR. The crude 5-year rates of IBTR for women with negative margins, positive margins, and indeterminate margins were 3.1%, 11.9%, and 6.9%, respectively. For women with negative margins, the 5-year and 10-year actuarial rates of freedom from IBTR were 96% and 92%, respectively, compared with 88% and 75%, respectively, for women with positive margins (P = 0.003). Univariate analysis demonstrated that the only factors associated with a significantly higher risk of IBTR were age at diagnosis (P < 0.050) and margin status (P = 0.005). Multivariate analysis showed that both age and margin status were independent predictors of IBTR. None of 24 patients with an EIC and negative margins were found to have developed an IBTR. CONCLUSIONS: The results of the current study were comparable to other published reports and supported the association of higher IBTR rates with positive or indeterminate margins compared with negative, pathologic margins. Furthermore, young age (age < 35 years at diagnosis) was associated with the highest risk of IBTR regardless of margin status.