A Sharp Scalpel Or A Mighty Pen The Legacy Of A.J. Cronin.

Archibald Joseph Cronin was born in Cardross, which currently lies in the local authority of Argyll and Bute, a few miles from Glasgow. Training to become a physician, Cronin graduated from the University of Glasgow in 1919 with a degree in medicine and with the hope of becoming a surgeon. Learning eagerly and constantly, working hard towards his desire of owning a practice in London's fashionable Harley Street, Cronin's ambition was shattered by a diagnosis of duodenal ulcer which forced him to take a break. Returning to his childhood dream of writing a novel, he published Hatter's Castle in 1933, the success of which was so immense that Cronin never returned to the medical field. This paper aims to highlight a few aspects of the writer's life and literary output in relation to his medical background.

Sacral (S1) herpes zoster.

Herpes zoster usually affects the thoracic and lumbar vertebra (T3-L3), while sacral herpes zoster has been very rarely reported. We present a very rare case of herpes zoster involving S1 dermatome in a 35-year-old healthy man who presented aching pain and typical herpes zoster eruption on the lateral aspect of the calcaneus, lateral plantar area and dorsal aspect of digits III and IV.

ER-/PR+ subset of invasive breast carcinoma (IBC): a distinct phenotype with good prognosis.

The expression of the estrogen (ER) and progesterone (PR) receptors in IBC patients represents a well-know prognostic and predictive factor. The existence of ER-/PR+ as a distinct phenotype, however, is controversial as well as is its prognostic significance. The aim of the study was to assess the incidence and prognosis in patients with ER-/PR+ IBC. One hundred and twelve patients with IBC were analyzed regarding ER/PR profile and survival. GraphPad prism 6 for Windows and Kaplan Mayer curve were used to determine overall survival (OS) and disease-free survival (DFS), with p < 0.05 as statistically significant. Of the 112 IBC patients, 75% were ER+/PR-, 16.07% were ER-/PR-, 7.14% were ER+/PR- and only 1.78% were ER-/PR+. OS was 100% in the ER-/PR+ group and 91.6% in the ER+/PR+ group. The lowest OS was found in the ER-/PR- group (72.2%), while OS was 100% in ER-/PR+ group. Regarding DFS, there were no statistically significant differences in the four groups (p = 0.11), although the highest DFS was found in the ER-/PR+ group (100%). ER-/PR+ tumors were associated with younger age (p = 0.72), smaller tumor diameter (p = 0.27), absence of lymph node metastases, and HER2 overexpression. Our results suggest that ER-/PR+ cases represent the rarest phenotype in IBC cases but its association with the best OS and DFS in other ER/PR phenotypes indicates an independent predictive value of PR for treatment considerations.

Keloidal-like local recurrence after infiltrating adenosquamous breast carcinoma with stromal-overgrowth mimicking a benign skin lesion.

We present a very rare case of an adenosquamous infiltrating breast carcinoma with sarcomatous stromal overgrowth of hypocellular collagenised type, which subsequently developed local recurrence, mistaken for a benign skin lesion due to bland keloid-like morphological appearance. All the histological, immunohistochemical, and clinical features must be taken into consideration when distinguishing between a benign skin lesion and a local recurrence of a rare subtype of breast carcinoma.

Transient yellow discoloration of the nails for differential diagnosis with yellow nail syndrome.

A differential diagnosis must be made between transient yellow discoloration of the nails and yellow nail syndrome. We highlight some practical aspects of yellow nail discoloration.

Does the Surgical Management of the Intercostobrachial Nerve Influence the Postoperatory Paresthesia of the Upper Limb and Life Quality in Breast Cancer Patients?

The aim of our study was to evaluate the extent to which the preservation or the section of the intercostobrachial nerve (ICBN) influences the development of postoperatoryparesthesia and to assess whether the development of paresthesiamay change the patient's life quality after surgical treatment for breast carcinoma. MATERIAL AND METHODS: We performed a nonrandomized retrospective study including 100 patients who underwent axillary lymph node dissection for infiltrating breast carcinoma associated with axillary lymph node metastases. Using a questionnaire we studied the patients general life quality in the postoperative period. For the statistical analysis we used GraphPad Prism, Fisher'™s exact test and Chi square test. Results: 100 patients were included in our study with a mean age of 59.7 years. In 50 cases, the ICBN was preserved (Group 1),while in the remaining 50 cases the ICBN was sectioned during surgery (Group 2). Significantly more patients from Group 2 complained about postoperative paresthesia (p=0.026). In our series, the management of the ICBN cannot be significantly correlated with the impairment of the patients daily activities (p=0.2), sleeping cycle (p=0.2), and general life quality after surgery (p=0.67). We can conclude that the management of ICBN has a great influence on the development of postoperative paresthesia. Although the paresthesia does not have a negative effect on the patient'™s life quality in the postoperative period, in our opinion it is important to preserve the ICBN in order to prevent postoperative paresthesia.

Intertrigo Caused by Streptococcus pyogenes.

Well-demarcated, beefy-red lesions of the skin folds, without satellite lesions, are the clinical hallmarks of intertrigo, frequently misdiagnosed especially in young children. We present 6 cases of streptococcal intertrigo to draw attention to this easily diagnosed and treated, but frequently overlooked, infection.

Bullosis Diabeticorum in a Young Child: Case Report of a Very Rare Entity and a Literature Review.

Bullosis diabeticorum (BD), or diabetic bulla, is 1 of the cutaneous manifestations of diabetes mellitus, reported in 0.5% of people with diabeties in the United States, mostly in adult men who have had long-lasting and uncontrolled diabetes associated with diabetic peripheral neuropathy. However, BD in young children is a mostly unrecognized entity. We present a case of BD in a 3-year-old girl with type 1 diabetes mellitus who had been treated with insulin for 7 months prior to hospitalization. Dermatologic examination revealed a large, tense bulla filled with clear fluid and not associated with pain or pruritus, localized on the lateral margin of the right hand. A 4 mm punch biopsy was taken from the peripheral edge of the bulla under local anesthesia, and histology showed subepidermal bulla and sparse nonspecific infiltrate in the dermis; direct immunofluorescence was negative to complements C3, IgM, IgG and IgA. The particularities of the present case include the bulla in the absence of local trauma or any other complications of diabetes and associated with well-controlled type 1 diabetes. The diagnosis was certified by histology, direct immunofluorescence and clinical outcome. To the best of our knowledge, BD in young children has been previously reported in only 2 other publications.