ABSTRACT
AIMS: To compare physical morbidity and health-related quality of life (HRQOL) in breast cancer patients who received standard axillary dissection (ALND) or sentinel lymph node biopsy (SLNB), followed by axillary dissection only in the case of sentinel-node positivity, within a randomised clinical trial. PATIENTS AND METHODS: Patients with early breast cancer < or =3cm and clinically negative axilla were randomly allocated to ALND or SLNB. All patients underwent physical examination every 6 months in order to assess any arm-related symptoms. A subset of patients completed the SF-36 quality of life questionnaire and the Psychological General Well Being Index (PGWBI) before randomisation, at 6 and 12 months after surgery and yearly thereafter. Results of the first 24 months are reported. RESULTS: Six-hundred and seventy-seven patients were available for analysis: 341 patients randomised to the ALND group and 336 to the SLNB group. Six months after surgery, the SLNB group had significantly less lymph-oedema, movement restrictions, pain and numbness with respect to the ALND group. Lymph-oedema was also significantly reduced at 12 months and numbness remained significantly less frequent in the SLNB arm at all time points. Three-hundred and ten patients participated in the HRQOL assessment. The mean scores of the PGWB questionnaire general index and anxiety domain were significantly better in the SLNB group than in the ALND group but the difference ceased to be significant at 24 months. CONCLUSIONS: The SLNB is associated with reduced arm morbidity without evidence of a negative impact on psychological well being. While waiting for long-term results of ongoing randomised clinical trials, the SLNB may be proposed for early stage breast cancer patients after adequate information on the expected advantages and the possible risks.
Subject(s)
Axilla/surgery , Breast Neoplasms/epidemiology , Breast Neoplasms/mortality , Lymph Node Excision/statistics & numerical data , Sentinel Lymph Node Biopsy/statistics & numerical data , Aged , Breast Neoplasms/pathology , Female , Humans , Italy , Middle Aged , Morbidity , Neoplasm Staging , Quality of Life , Surveys and QuestionnairesABSTRACT
We report a case operated for gastric metastasis of a cutaneous melanoma. Although such localizations are frequent, symptomatology is nonspecific. Diagnostic fibroscopy is effective if the lesion is blackened by melanin. Immediate surgery is required to avoid acute complications. The indication for elective surgery can be raised if there is a solitary metastasis. In case of recurrence, subtotal gastrectomy appears to be possible. Although the prognosis is poor, surgery offers important palliative relief.
Subject(s)
Melanoma/pathology , Skin Neoplasms/pathology , Stomach Neoplasms/secondary , Aged , Female , Gastrectomy , Humans , Leg , Lymphatic Metastasis , Stomach Neoplasms/diagnosis , Stomach Neoplasms/therapy , Treatment OutcomeSubject(s)
Appendix , Drainage/adverse effects , Hernia, Ventral/etiology , Mucocele/etiology , Postoperative Complications/etiology , Appendix/diagnostic imaging , Cecal Diseases/diagnosis , Cecal Diseases/etiology , Cholecystectomy, Laparoscopic , Diagnosis, Differential , Drainage/instrumentation , Emergencies , Hernia, Ventral/diagnosis , Humans , Male , Middle Aged , Mucocele/diagnosis , Postoperative Complications/diagnosis , Radiography , Time Factors , UltrasonographyABSTRACT
Investigation of a patient with rectal bleeding showed the hemorrhage to be due to a lipoma of mesocolon protruding into the transverse colon. A literature review failed to discover a report of a similar case.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Lipoma/complications , Mesocolon , Peritoneal Neoplasms/complications , Humans , Lipoma/pathology , Lipoma/surgery , Male , Middle Aged , Neoplasm Invasiveness , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/surgeryABSTRACT
One case of bronchogenic cyst of the pancreas associated to a true gastric cyst produced by duplication is described. Such congenital neoformations are extremely rare. The symptoms are highly variable. The diagnosis can be established only through the histopathological study of the surgical specimen.
Subject(s)
Bronchogenic Cyst/complications , Cysts/complications , Pancreatic Diseases/complications , Stomach Diseases/complications , Adult , Bronchogenic Cyst/pathology , Bronchogenic Cyst/surgery , Cysts/pathology , Cysts/surgery , Female , Humans , Pancreatic Diseases/pathology , Pancreatic Diseases/surgery , Stomach Diseases/pathology , Stomach Diseases/surgeryABSTRACT
The authors report a case of spontaneous gastric rupture due to acute distension following an episode of bulimia. A two stage surgical procedure was performed with a favorable outcome. The difficulty in the choice of therapy was confirmed in a review of the literature. A minor surgical intervention involving a lesser degree of trauma may be chosen, and after appropriate resuscitation, definitive surgery can be planned.
Subject(s)
Bulimia/complications , Stomach Rupture/surgery , Acute Disease , Adult , Anastomosis, Roux-en-Y , Drainage , Female , Humans , Radiography , Rupture, Spontaneous , Stomach Rupture/diagnostic imaging , Stomach Rupture/etiologyABSTRACT
A case of intestinal haemorrhage due to ectopic ulcerated gastric mucosa in Meckel's diverticulum in a young male is reported. The haemorrhage was stopped 5 days after continuous infusion with ranitidine (6 fials in 500 cc of physiological solution X 2). The therapy also proved effective in cases of bleeding ectopic gastric mucosa.
