Can saline be an alternative to aesthetic surgery in extended breast quadrantectomy?

OBJECTIVE: To explore other simpler options sparing the patients the morbidity and cost in extended breast quadrantectomy. METHODS: This prospective study was undertaken at King Fahd Hospital of the University, Al-Khobar, Eastern Province of Saudi Arabia between 1999-2005. Factors considered for patients undergoing breast-conserving surgery were based on age, tumor size, pathological characteristics, and patient's preference. Frozen section was adopted in all procedures to insure negative margins. After extended quadrantectomy, 200-400 cc was injected into the cavity to retain breast contour. Magnetic resonance imaging was used for postoperative assessment. RESULTS: Twenty-four patients were included, aged 28-43 years and tumor size 3-5 cms. All margins were negative on frozen section. The contour of the breast was restored with saline, MRI was employed for follow up at the immediate post operative period and at 4-6 months, it demonstrated restored breast contour and the saline filled cavity replaced by lipo-fibrous tissue. Follow up after 4-24 months showed that all patients noticed some degree of asymmetry, yet were satisfied with the result, none required or requested additional surgery. CONCLUSION: In large tissue excisions injecting saline into cavities temporarily prevents the caving in of the redundant skin, which has the tendency to permanently adhere to the fascia thereby preventing gross deformities. It has proven effective, contour storing and scored high satisfaction among patients. It certainly does not replace cosmetic breast surgery, however, it should be considered in centers were onco-plastic surgery is not readily available.

BRCA1 and BRCA2 mutations in breast cancer patients from Saudi Arabia.

OBJECTIVE: The aim of this pilot study was to screen the major segments of the BRCA1 and BRCA2 genes for disease-associated mutations in Arab and Asian women with breast cancer from the Kingdom of Saudi Arabia. METHODS: Deoxyribonucleic acid samples from 29 Arab women and 11 Asian women, with unilateral breast cancer were investigated for BRCA1 and BRCA2 mutations. For this purpose single strand conformation polymorphism and direct nucleotide sequencing techniques were employed. This study was carried out at King Fahad Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, during the time frame March 2000 through to August 2001. RESULTS: One novel BRCA2 truncating mutation, the frame-shift mutation 2482delGACT, was uncovered in an Arab patient of Palestinian descent. This mutation is a 4-nucleotide deletion that creates a stop signal at codon 770 of the BRCA2 transcript. The BRCA1 disease-associated mutation Arg841Trp was detected in another Arab patient from Egypt. The clinical presentation in the 2 heterozygous carriers of these 2 mutations is described here. In addition the unclassified BRCA1 variant Phe486Leu combined with Asn550His, and the unclassified BRCA2 variant Asp1420Tyr, were identified in Arab patients. Five BRCA1 polymorphisms and 6 BRCA2 polymorphisms were detected at different allele frequencies in both mutation carriers and patients with normal genotype. CONCLUSION: We conclude that BRCA1 and BRCA2 mutations are likely to contribute to the pathogenesis of familial breast cancer in female patients from the Kingdom of Saudi Arabia.

Thyroid tuberculosis mimicking carcinoma: report of two cases.

Among 527 patients with thyroid disease who underwent surgery at our hospital during a 20-year period, 2 (0.4%) had tuberculous thyroiditis mimicking carcinoma. The first patient was a 44-year-old man with a solitary thyroid nodule and the second was a 24-year old man with a thyroid abscess. The unexpected diagnosis was made postoperatively and was based on histological findings in both patients. No primary focus was found elsewhere in either patient, and both responded to antituberculous chemotherapy. Although the diagnosis is usually based on examination of resected specimens, recent reports indicate that find-needle aspiration cytology is a cost-effective technique of diagnosing thyroid tuberculosis. A review of 35 cases reported in the English literature is also discussed.