Higher rate of progesterone receptor positivity in skeletal metastases of breast cancer with a pathological fracture vs those without fracture.

Identifying risk factors for fracture occurrence in breast cancer (BC) skeletal metastases (SM) may guide the management of such bone deposits. There is sparse evidence regarding receptor status in SM and their relationship to fracture occurrence. Our study aimed to determine the relationship between estrogen (ER), progesterone (PR) and HER2 receptor status and Ki-67 index and fracture occurrence in SM of BC. Exactly 152 samples of SM of BC obtained from individual patients were evaluated. The status of the aforementioned receptors and Ki67 index were determined in SMs samples. Their expression was compared between SM that did and did not develop a fracture. Ninety-one cases sustained a pathological fracture at the SM site, and 61 did not. Patients who sustained a pathological fracture had a higher rate of PR positivity at their SMs as compared to those with no fracture. There was no significant difference between the two groups concerning ER, HER2+ or Ki67 status. SMs secondary to BC with a fracture are more likely to be PR positive than those with no fracture. Determining the receptor status in SMs may identify high-risk groups for fracture occurrence, and determining the PR status may also guide surgical and hormonal therapy.

Perioperative hypertonic saline may reduce postoperative infections and lower mortality rates.

BACKGROUND: To determine the effects of hypertonic saline (HS) as fluid resuscitation during or after major spinal surgery. We hypothesized that the administration of HS perioperatively would decrease morbidity and mortality rates. METHODS: A two-year retrospective, pair-matched, case-control study of adult patients (57 pairs matched 1:1) admitted to the intensive care unit (ICU) after major spinal procedures in a tertiary- and quaternary-care university medical center. Patients were matched for year of operation, operation site and magnitude, age, and sex. Each pair consisted of a patient who received HS either intraoperatively or postoperatively (Study patient) and a Control patient (isotonic fluids). RESULTS: No significant differences were seen in the underlying diseases. Neither the percentage of patients extubated in the operating room (OR) (Study, 44%; Control, 51%) nor the total time of intubation differed in the two groups. Patients receiving HS were in the operating room slightly longer. Length of stay (LOS) in the ICU was a median of 22 h in both groups. Hospital LOS was 7.7 +/- 6.1 days in the HS group and 7.3 +/- 3.5 days in the Control group (p = 0.98). Three infections occurred in the HS group and 11 in the Control group (p = 0.04). The total number of patients with one or more other complications was 11 in the HS group and 16 in the Control group (p = 0.19). Death occurred in two patients in the HS group and seven patients in the Control group (p = 0.08). CONCLUSIONS: Perioperative use of HS in major spinal surgery was associated with fewer postoperative infections, as well as trends toward fewer complications and a lower mortality rate. Further studies with strict protocols are warranted.

Alcohol and the accident and emergency department: a current review.

Alcohol misuse constitutes a major problem in our modern society and both physical and mental alcohol-related harm result in a large number of Accident and Emergency (A&E) attendances, thus imposing a significant burden on the workload and financial resources of the department. The current management of problem drinking by most A&E departments could be further improved. The introduction of a holistic approach that includes efficient screening instruments and effective brief, anti-alcoholic interventions, for the management of these patients must be considered. This should strengthen the preventive role of A&E departments, and, in the long term, may result in a decrease in the number of cases of alcohol misuse and in alcohol-related attendances.