A series of carcinoid tumours of the breast.

Eight patients with a carcinoid tumour of the breast were treated between 1985 and 1992. All were reviewed for their history, physical examination, mammographic and ultrasound features. Staining methods according to Grimelius, with H&E and Neurone Specific Enolase were repeated, and all were positive. In only one patient was a positive axillary lymph node found. No recurrences were seen during follow-up. In agreement with the available literature there seems to be a less aggressive behaviour of carcinoid tumours of the breast in patients over 65 years of age. When a carcinoid tumour is suspected in this age group, the diagnosis can be confirmed by (immuno)histological analysis of a needle biopsy. If the diagnosis of carcinoid is confirmed, a limited operation, without an axillary lymph node dissection, may be considered.

Sweet syndrome associated with liposarcoma: a case report.

A 36-year-old woman with a dedifferentiated liposarcoma is described who had suffered from Sweet syndrome in the past. From the literature a relationship between this syndrome and malignancy is known to exist. However, the combination of Sweet syndrome with a sarcoma has not previously been reported.

Familial varices of the colon.

Two patients from the same family with varices throughout the entire colon and no apparent portal hypertension, are described. One patient experienced profuse bleeding after polypectomy, the other had recurrent rectal blood loss.

Quality of life with a temporary stoma: ileostomy vs. colostomy.

PURPOSE: The hypothesis is that the impact of a temporary stoma on a patient's daily life is determined by complications and related stoma care problems. METHOD: A prospective clinical trial was performed, studying complications and social well-being of 37 patients with loop ileostomy and 39 patients with a loop colostomy (randomly assigned comparison). Patients were categorized according to degree of social restriction. The association between the degree of social restriction and the presence of stoma care problems and complications was assessed. Follow-up was scheduled every three months until the stoma was closed (94 percent). RESULTS: There is no relation between stoma type (ileostomy or colostomy) and degree of social restriction (chi-squared test, P = 0.42). The more stoma care problems or complications seen, the higher the degree of social restriction: significantly more stoma care problems were seen in the completely isolated group of patients when compared with the patients who were less socially restricted (Spearman correlation coefficient 1 = 0.35, P = 0.003). Especially stoma leakage, peristomal skin irritation, dietary prescriptions, retraction, and prolapse of the stoma have significant impact on the patient's daily life. CONCLUSION: Stoma surgery has a great influence on a patient's daily life. There is a clear relation between the number of stoma care problems and the degree of social restriction. Follow-up of stoma patients under close surveillance of stoma care nurse to minimize stoma care problems and a careful surgical technique are advocated for good stoma care.

Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy.

BACKGROUND: Loop ileostomy or loop transverse colostomy for temporary decompression of a left colonic anastomosis represents an important issue in abdominal surgery. METHODS: A randomized study, comparing loop ileostomy (n = 37; group 1) or loop transverse colostomy (n = 39; group 2), was conducted. Patients were followed from construction to closure of the stoma. RESULTS: Age, weight, sex and indication for surgery were similar in both groups. After stoma construction complications were reported in nine of 37 patients in group 1 and in one of 39 in group 2 (P < 0.01), leading to postoperative death in five of 37 in group 1 and one of 39 in group 2. In the period between stoma construction and closure significant differences were observed only in prolapse rate (one of 32 group 1, 16 of 38 group 2; P < 0.01), need for temporary adaptation of clothing (eight of 32 group 1, 22 of 38 group 2; P < 0.01) and dietary guidelines (23 of 32 group 1, four of 38 group 2; P < 0.01). One patient died in group 1 and four in group 2; the deaths were not stoma related. After stoma closure eight of 29 patients in group 1 had complications and there were two deaths compared with three of 32 and no deaths in group 2. CONCLUSION: Both types of stoma carry a high complication rate with a considerable associated mortality rate. The interval between stoma construction and closure has substantial impact on social and economic status. Based on all three phases studied, routine use of transverse colostomy is advised if decompression of the left colon is indicated.

Survival of proximal third gastric carcinoma.

BACKGROUND AND OBJECTIVES: Proximal third gastric carcinoma is a distinct clinical entity compared with tumors located in other parts of the stomach with a rapid increasing incidence and a poor prognosis. This study was done to evaluate therapy for, and survival of, patients with gastric cardia carcinoma. METHODS: Clinical features and prognosis of 49 patients with proximal third gastric carcinoma between 1985 and 1995 (mean age 69.7 years) were evaluated. RESULTS: In 20 of the 49 patients, laparotomy was excluded because of widespread disease and/or poor clinical condition at presentation. Palliative therapy consisted of gastric tube implantation (n = 4), dilation (n = 3), or radiotherapy (n = 4). In 9 patients, no specific palliative therapy was indicated. Twenty-nine patients underwent laparotomy (59%). In 13 patients, a total gastrectomy with esophagojejunostomy was performed, and in 7 patients a partial gastrectomy was performed. In 9 cases, the tumor was irresectable. In 8 of these 9 patients, a Celestin tube was implanted. Median survival in all patients was 7 months and the expected probability of survival after 50 months was zero. The median survival of patients who underwent a resection was significantly better than in those in whom no resection was performed (23 vs. 4 months, P = 0.047). CONCLUSIONS: We conclude that long-term survival of patients with proximal third gastric carcinoma is poor. However, long-term survival may be best warranted when patients present at an early stage and resection can be performed.