[Investigation of Patients with Stage â £ Breast Cancer Who Underwent Primary Tumor Resection].

We investigated whether primary tumor resection performed at our department for the purpose of local control affects the disease progression of Stage Ⅳ breast cancer. Fifteen patients who underwent primary tumor resection between 2009 and 2017 were investigated. The median age at the time of surgery was 63 years. There were two postoperative deaths(1 at<1 year postoperatively and 1 at<2 years postoperatively). The median postoperative stable disease(SD)period was 11 months overall and was 12 months or longer in 7 patients. SD was attained by all patients with the first drug treatment after primary tumor resection. Patients who tended to have a longer postoperative SD period did not receive preoperative drug treatment, were luminal HER2-positive, and had one metastatic organ. Regardless of surgery timing and reason, there were no cases of rapid postoperative disease progression. In all patients, postoperative local control was satisfactory, and continuation of medical treatment was feasible for distant metastatic tumors. These data signify that primary tumor resection can be considered to treat Stage Ⅳ breast cancer for the purpose of local control.

[A case of spontaneous epidural emphysema occurring during sleep].

A 19-year-old man consulted a doctor for swelling of his neck and shortness of breath. The day before, he woke up with a slight cough and upper chest pain early in the morning. He went to school and spent the day as usual. He did not have a history of asthma or violent cough. The next day, chest radiography showed subcutaneous emphysema and pneumomediastinum. Computed tomography not only confirmed the presence of mediastinal and subcutaneous air, but also demonstrated a linear radiolucent stripe in the spinal canal corresponding to epidural emphysema. The patient did not have any neurologic findings. His general condition remained good except that his arterial blood oxygen saturation slightly decreased to 95%. Laboratory data were normal, except for serum IgE, which was elevated (2072 IU/ml). He stayed at rest and was treated conservatively and his symptoms improved within a few days. Seven days later, the intraspinal air and pneumomediastinum had resolved spontaneously on follow-up chest computed tomography (CT).