Prognostic significance of occult lymph node metastases in node-negative breast cancer.

BACKGROUND: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer originally reported to be histologically node negative. None of the patients received adjuvant systemic therapy. METHODS: Five additional levels from formalin-fixed, paraffin-embedded nodes were examined at 150-microns intervals with H&E staining and a cocktail of antikeratin antibodies (AE1/AE3) recognizing low molecular weight acidic keratins. RESULTS: Nodes from 11 (12.8%) of 86 patients contained occult metastases. All metastases identified by cytokeratin antibody were also detected in H&E-stained sections. With median follow-up of 80 months, distant metastases occurred in five of 11 occult node-positive patients (45%) and 13 of 75 patients whose nodes were negative on review (17%). Median time to recurrence was 89 months for occult node-positive patients and not yet reached for node-negative patients (p = 0.048). The disease-specific 5-year survival rate was 90% for occult node-positive patients and 95% for node-negative patients. CONCLUSIONS: The presence of occult metastases shortened the disease-free interval and suggested that more diligent axillary staging would more accurately identify patients who would benefit from systemic adjuvant treatment.

Early onset of tetany following thyroidectomy: report of two cases.

The most common complication of total thyroidectomy is hypocalcemia. Following thyroidectomy, especially total thyroidectomy, the serum calcium usually falls gradually and patients do not usually require supplementary medication before 24 hours. Two cases of total thyroidectomy are presented in which the preoperative serum calcium levels were normal and hypocalcemic tetany developed in the recovery room immediately after the operation. The hypocalcemia was a temporary phenomenon, and neither patient requires supplementary calcium at the present time. There is no good explanation for this precipitous drop in the serum calcium levels in these two patients.

[Protection against mercuric chloride nephropathy by sodium selenite in the rat]. / Protection de la néphropathie au chlorure mercurique par le sélénite de sodium chez le rat.

Daily intraperitoneal injection of 2.5 or 5 mumole HgCl2 to male Rats weighing 250 to 350 g induces an early intense increase of urine gamma-glutamyl transferase activity. In the same conditions, equimolecular administration of sodium selenite and mercuric chloride induces no increase of the enzymuria for the low dose: for the high dose- a minor and more persistent increase of urine GGT is observed. Thus, the activity of urines GGT allows, in vivo, to establish that sodium selenite protects Rat kidney against toxic effects of mercuric chloride.

Urine gamma-glutamyl transferase in rat kidney toxicology: nephropathy by repeated injections of mercuric chloride. Effects of sodium selenite.

Groups of 5 male and 4 female Cobs CD rats weighing 250--350 g were injected intraperitoneally, daily for 15 days, with 5 mumol HgCl2/kg, 5 mumol Na2SeO3/kg, or (5 mumol HgCl2 + 5 mumol Na2SeO3)/kg in a 10 ml/kg vol. of saline. Control animals were injected with saline only. Injection of saline or sodium selenite produced neither modification of diuresis, nor of urine elimination of sodium, potassium, chloride, phosphates, urea, creatinine and gamma-glutamyl transferase (GGT). Injection of mercuric chloride induced a massive increase of urine GGT, diuresis and phosphaturia and a decrease of kaliuria and natriuria. Those effects reflect a kidney tubular lesion which seems to be more severe in males than in females. Injection of mixed sodium selenite and mercuric chloride or separate injection of both compounds had similar effects. In both sexes, urine GGT elimination was delayed and about 2 times lower than with HgCl2 alone. In females, the other urine parameters were almost normal whereas in males, diuresis and phosphaturia were slightly increased and kaliuria decreased. The observation of urine GGT elimination attests, in vivo, that sodium selenite decreases tubular toxicity of mercuric chloride and resulting kidney function disturbances.