Questioning the role of axillary node dissection in sentinel node positive early stage breast cancer in the South Eastern Cancer Centre.

INTRODUCTION: Axillary node status is a predictor of breast cancer survival. Axillary node dissection (ALND) following positive sentinel node biopsy (SLNB) is challenged by the American College of Surgeons Z0011 trial, where clinically/radiologically node-negative, SLNB positive early stage patients failed to derive therapeutic benefit from ALND at 6 years. AIMS: To quantify the rates of non-sentinel lymph node positivity after ALND in all breast cancer stages. To assess Z0011 trial result application to an Irish patient population. METHODS: Retrospective review of a prospectively maintained database of clinically node-negative patients undergoing breast conserving surgery and ALND for a positive SLNB from January 2011 to January 2012. RESULTS: Of 174 new breast cancers diagnosed, 144 underwent surgery of which 127 patients were clinically/radiologically node-negative; 46 patients were SLNB positive; 34 (73.9 %) proceeded to ALND. Of 9 T1 tumours, 3 (33.3 %) had further positive nodes on ALND. Of 24 T2 tumours, 11 (45.8 %) had further positive nodes on ALND. All 3 (100 %) T3/T4 tumours had further positive nodes on ALND. Mean numbers of sentinel and axillary nodes harvested were 2.3 and 15.2, respectively. In the SLNB positive, ALND negative group, 12 of 18 (66.7 %) patients were <60 years versus 14 of 17 (82.4 %) in the SLNB positive, ALND positive group. This may be indicative that younger women have a trend toward node positivity following ALND for a positive SLNB. CONCLUSION: These data suggest that a significant proportion (41.9 %) of T1/T2 tumours undergoing ALND following positive SLNB have further positive nodes. It may be premature to exclude ALND in patients with T1/T2 tumours following a positive SLNB.

Changes in outcome following surgery for colorectal cancer: one surgeon's experience.

BACKGROUND: Colorectal cancer (CRC) has the second highest mortality rate of all cancers in Ireland. Developments in imaging, surgical technique, and perioperative care in the last two decades have altered management. AIMS: To determine whether outcome following surgery for CRC in the mid-west has changed over a 22-year period. METHODS: Four hundred and twenty-two patients were divided into two time periods: Group A (1980-1991, n = 203) and Group B (1992-2002, n = 219) and demographic, inpatient, and survival data were reviewed. RESULTS: The mean age was 67 years, 59% were male. Group B patients had less advanced disease at presentation (Dukes' stage D 14% vs 22%, p < 0.05), fewer perioperative complications (13% vs 23%, p < 0.05), and fewer local recurrences (6.8% vs 11.8%, p < 0.05) than Group A. No difference in 30-day mortality rate or survival was detected. CONCLUSIONS: Although perioperative CRC management has improved, methods of earlier diagnosis and improvements in adjuvant therapy should be explored to improve survival.

Preliminary study of prairies forested with Eucalyptus sp. at the northwestern Uruguayan soils.

The land cover change of Uruguayan Forestal Plan provoked biogeochemical changes on horizon Au(1) of Argiudols; in native prairies which were replaced by monoculture Eucalyptus sp. plantation with 20 year rotations as trees. Five fields forested and six natural prairies were compared. The results not only show a statistical significant soil acidification, diminution of soil organic carbon, increase of aliphaticity degree of humic substances, and increase of affinity and capacity of hydrolytic activity from soil microbial communities for forested sites with Eucalyptus sp. but also, a tendency of podzolization and/or mineralization by this kind of land cover changes, with a net soil organic lost of 16.6 tons ha(-1) in the horizon Au(1) of soil under Eucalyptus sp. plantation compared with prairie. Besides, these results point out the necessity of correction of the methodology used by assigned Uruguayan commission to assess the national net emission of greenhouse gases, since the mineralization and/or podzolization process detected in forested soil imply a overestimation of soil organic carbon. The biochemical parameters show a statistical significant correlation between the soil organic carbon status and these parameters which were presented as essential for the correct evaluation of Uruguayan soil carbon sink.

[Foreign body ingestion among prisoners]. / Ingestión de cuerpos extraños en reclusos.

The records of 261 prisoners who purposely ingested foreign bodies are analyzed retrospectively. The data include type, shape, and number of foreign bodies as well as localization, clinical repercussion, evolution of patients, and the treatment they received. Laparotomy was necessary in 41 cases (15.7%) due to severe complications like obstruction, hemorrhage or perforation. All of our patients operated on had an uneventful postoperative course, without mortality. In our series, there were patients with more than one episode of ingestion of foreign bodies and others who needed reoperation.