Bilateral DCIS following gynecomastia surgery. Role of nipple sparing mastectomy. A case report and review of literature.

Bilateral ductal carcinoma in situ of breast is a very rare disease in men. Ductal carcinoma in situ (DCIS) is an abnormal proliferation that involves the ductal epithelium and it has the potential of evolving into an invasive tumour. Gynaecomastia (female like breast in men) is a benign condition though it is associated with a reported 3% incidence of unilateral invasive breast cancer.(2) Synchronous bilateral breast cancer in association with gynaecomastia is exceptionally rare. The recommended treatment for DCIS in male is mastectomy. So far only 2 cases of bilateral DCIS in male patients has been reported in the literature treated with skin and nipple sparing mastectomies. We report another case of synchronous bilateral DCIS in a male treated with skin and nipple sparing mastectomies. A 44 year-old man with history of long-standing gynecomastia. He had no identifiable risk factor for the development of cancer. His pre operative assessment of breast including mammograms was normal. He underwent bilateral subcutaneous mastectomies, with subsequent incidental diagnosis of synchronous bilateral ductal carcinoma in situ. The case was discussed in multidisciplinary team meeting and the need for further surgery was felt including excision of nipple areola complex. However considering patient wishes, cosmetic outcome and recent literature it was decided to preserve nipple areola complex (NAC) with regular follow up evaluation. Our patient at completion of 18 months of treatment is doing well with no signs of local recurrence.

The obscure autopsy and neuroleptic malignant syndrome.

The technique of immunocytochemistry was used to identify myoglobin in kidney, confirming a diagnosis of neuroleptic malignant syndrome following an otherwise obscure autopsy in a decomposed body. The features of neuroleptic malignant syndrome are reviewed with a differential diagnosis of myoglobin renal casts. The report emphasizes a thorough and detailed assessment of deaths which occur during treatment with neuroleptic drugs.

The incomplete cone biopsy: a comparison of conservative and surgical management.

OBJECTIVE: to determine the reliability of conservative management of cone biopsies showing apparently incomplete excision of cervical intraepithelial neoplasia (CIN) by comparing surgical and conservative management. DESIGN: a retrospective study. SUBJECTS: 74 consecutive cone biopsies with a histology report of apparently incomplete excision of CIN 2 or CIN 3 from a series of 738 cone biopsies. MAIN OUTCOME MEASURES: the presence of CIN at hysterectomy against the pick up rate in conservatively managed patients. RESULTS: where excision appeared incomplete at the ectocervix this was confirmed in 1 of 6 (16.7%) of patients managed surgically and 2 of 17 (11.8%) of patients managed conservatively (P = 0.40). Where excision appeared incomplete at both endo- and ectocervix, 5 of 6 (83.3%) were confirmed to have incomplete excision in the surgical group, and 3 of 5 (60%) had further proven CIN in the conservative group (P = 0.34). Where excision appeared incomplete at the endocervix only, this was confirmed in 7 of 22 (32%) of cases managed surgically, but only 2 of 18 (11.1%) of cases managed conservatively had further proven CIN (P = 0.14). Combining all patients with incomplete excision at the endocervix irrespective of the ectocervix status revealed confirmation of residual CIN in 12 of 28 (42.9%) patients managed surgically and in 5 of 23 (21.7%) patients managed conservatively (P = 0.097). CONCLUSIONS: management should depend on the site of the apparent incomplete excision. Where excision appears incomplete at the ectocervix only, cytological follow up should be employed. If the endocervix is involved, further excisional surgery may be more appropriate.

Rapidly fatal necrotising fasciitis caused by Streptococcus pyogenes.

AIMS: To describe the morbid anatomical and bacteriological features in a series of five cases of rapidly fatal Streptococcus pyogenes necrotising fasciitis. METHODS: Post mortem and bacteriological examinations were made of five patients dying within 48 hours from rapidly fatal necrotising fasciitis. RESULTS: All five cases died rapidly from a toxic Streptococcus toxin syndrome as a result of developing necrotising fasciitis following trivial injury. CONCLUSIONS: Necrotising fasciitis caused by Streptococcus pyogenes infection can be rapidly fatal. This is probably the result of a toxic shock syndrome. Rapid, early diagnosis and swift and probably empirical treatment is required to avoid a fatal outcome.

Cold coagulation therapy in the treatment of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix.

The efficacy of cold coagulation therapy in the treatment of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix, was studied among 65 patients who also had genital warts. This therapy was found to be successful as the failure rate was only 8%. There were no serious side-effects. The treatment can be administered easily in an out-patient setting after histological confirmation. This study also showed that if, on the other hand, a subclinical HPV infection is not treated, it may develop into a clinical disease (genital warts) within two years. Therefore long-term follow-up of this condition may be necessary in untreated cases.

Cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix.

The aim of the study was to establish the efficacy of cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix. Women with genital warts who had subclinical HPV infection of the cervix and no other sexually transmitted diseases were followed up at six weeks, 12 weeks, six months, 12 months and 18 months after treatment with cryotherapy. They came to the out-patient department of genito-urinary medicine (GUM) at St Luke's Hospital, an open clinic without any appointment system. Two hundred and fifty-five patients with genital warts took part in the study. They underwent clinical genital examination, along with cytology, colposcopy and colposcopically directed cervical punch biopsies. Sixty-three of them had subclinical HPV infection of the cervix only, and were considered suitable for cryosurgery. Twelve weeks after treatment only one patient developed clinical warts on the cervix, which increased to three patients (4.8%) after 12 months. No further patients developed any clinical cervical warts. In the untreated group development of clinical warts was noticed in five patients (20%) after 18 months. The difference was significant. The failure rate for the histologically diagnosed subclinical HPV infection was 38% in the treated group, whereas it persisted in 76% of the untreated group. Cryotherapy was found to be successful in the treatment of subclinical HPV infection and prevented the development of clinical disease. There were no serious side-effects and the treatment can be administered easily in an out-patient setting after histological confirmation.

Regional odontodysplasia: report of case.

A case is reported of a nine-year-old white female with regional odontodysplasia involving the maxillary right quadrant and the construction of a temporary acrylic removable prosthesis, to provide function and to increase vertical dimension.

Oral trauma in children: a hospital survey.

The purpose of this investigation was to determine the type and prevalence of dental injuries seen in a hospital emergency room. Of the 10,436 patients who were treated at the hospital emergency room as a result of a traumatic episode, 765 (7.3%) had sustained injuries to structures of the oral cavity. The leading cause of dental injury was falls, accounting for 55.8% of the injuries. The male-to-female ratio of dental injuries was 1.6:1. The peak age group of children with dental injuries was the 1-to-2-year-old age group. Laceration of the lip was the most predominant injury to structures of the oral cavity, accounting for 62.8% of the dental injuries. The peak month for dental injuries was June, and 61.2% of the dental injuries occurred in the home.

Bilateral mandibular dentigerous cysts in a five-year-old child: report of a case.

This is the youngest patient reported in the literature with bilateral mandibular dentigerous cysts. This report confirms the importance of a panoramic radiographic examination in diagnosing bony lesions of the jaws. Early diagnosis and aggressive treatment of these lesions is essential to avoid the undesirable sequelae that could occur without treatment. Dentigerous cysts are bony lesions that have the potential to produce neoplasms.

Rubinstein-Taybi syndrome: case report.

A patient with Rubinstein-Taybi syndrome is presented with the characteristic clinical features including small and short stature, severe mental retardation, and small maxilla with a dental malocclusion. Treatment for this patient was accomplished utilizing a general anesthetic. These special patients who lack the ability to accept dental treatment in the normal situation require extensive and comprehensive dental treatment compared with nonhandicapped patients.