Incisional metastatic breast carcinoma deposit in a total knee replacement presenting as peri-prosthetic joint infection-a case report.

Cutaneous metastasis from the primary breast carcinoma occurs when the disease is wide spread and can present as skin infection especially in a previous well-healed scar. If the secondary deposit is over a total knee incisional site it can mimic peri-prosthetic joint infection. We report a rare and unusual case of a woman who presented with clinical signs and symptoms of a peri-prosthetic total knee replacement which on biopsy turned out to be cutaneous metastasis from a previously treated breast cancer. Chronic granulation tissue in a total joint incisional scar may present as peri-prosthetic joint infection. A good history taking and clinical examination with specimens from the skin lesions send for both microbiology and histopathology is recommended to arrive at an early and accurate diagnosis.

Can the Kattan nomogram still accurately predict prognosis in renal cell carcinoma using the revised 2010 tumor-nodes-metastasis reclassification?

The Kattan nomogram has been used in renal cell cancer to predict progression-free survival after nephrectomy. Tumor-nodes-metastasis staging is essential for the calculation of this score. The effect of the recent 2010 revision to the tumor-nodes-metastasis classification on the predictive ability of the Kattan nomogram was studied. All patients having radical nephrectomy for renal cell cancer in the 5-year period of 2004-2008 at a tertiary referral center were included. Pathological and radiological records were reviewed to identify tumor-nodes-metastasis stage (2002 and 2010 classifications). Kattan scores were calculated for the 2002 and 2010 tumor-nodes-metastasis stages, and the effect on survival predictions were compared with actual outcomes. A total of 291 patients with non-metastatic renal cell cancer were identified. Revision of the tumor-nodes-metastasis staging from the 2002 to 2010 classification resulted in an increase in the number of patients with stage pT3a (from 30 to 75), a reduction in the patients with stage pT3b (from 57 to 10) and a small increase in stage pT4 cases (1 to 3). This altered the proportion of patients in the Kattan prognostic of "good" (from 61% to 69%), "intermediate" (from 29% to 22%) and "poor" (from 10% to 8%). The overall median predicted 5-year progression-free survival was 79.8% with 2002 tumor-nodes-metastasis, and 81.8% with 2010 tumor-nodes-metastasis. Actual 5-year progression-free survival was 83.0%, which was not significantly different from that predicted using either tumor-nodes-metastasis classification (P = 0.66). On comparing the new 2010 and old 2002 tumor-nodes-metastasis classification in our cohort, we showed the predictive ability of the Kattan nomogram remained unaltered.

Patient information in otorhinolaryngology: a prospective audit.

OBJECTIVES: The aim of patient information is to involve patients in their condition and their treatment. The literature states that good information can improve medical outcomes, reduce patient anxiety and that patients want access to it. We wanted to calculate the provision of written patient information to ENT day-case patients, measure information recall and patient satisfaction. DESIGN: A prospective audit cycle. The first cycle of the audit studied patients receiving current practice, where verbal information was provided but written patient information was not routine. Following a departmental drive towards provision of written patient information, a second cycle was audited. A questionnaire on admission to the ward on the day of surgery was used to measure outcomes. SETTING: The ENT Department of a UK university teaching hospital. MAIN OUTCOME MEASURES: The number of patients receiving written patient information, the rate of recall of complications and patient satisfaction with the information provided. PARTICIPANTS: One hundred patients undergoing day-case surgery were included. The first cycle of the audit studied 50 consecutive patients, receiving current practice. The second cycle, following implementation of change, studied a further 50 consecutive patients. RESULTS: Following a departmental drive towards provision of patient information, 64% of patients received written patient information improving the rate of recall of the majority of complications from 24% to 52%. There was no significant difference in patient satisfaction between groups. CONCLUSIONS: Written patient information leaflets are a useful tool to improve recall of information given to patients, in order to facilitate informed consent.