Comparison of bone scanning and CA 15-3 serum concentration in the follow-up of breast cancer.

The follow-up bone scans (BS) of 158 women with breast cancer and without known bone metastases were reviewed and compared with serum CA 15-3 concentration. Ninety-three BS were systematic (normal serum CA 15-3) and 3 corresponded to proven bone metastases. Sixty-five BS were motivated:-by isolated bone pain (20 BS. 1 corresponding to metastases),-by bone pain and signs of progression of the disease (11 BS. 7 corresponding to metastases: elevated serum CA 15-3 except in one case), by known visceral metastases (20 BS. 6 corresponding to metastases with elevated serum CA 15-3), by an isolated increase of serum CA 15-3 (7 BS. 4 corresponding to metastasis) by local recurrence (7 BS. 1 corresponding to metastasis). These results show that bone metastases were diagnosed in 6 patients whose serum CA 15-3 concentration was normal. We conclude that the existence of normal tumor markers is not sufficient to exclude the possibility of bone metastases.

CA 15-3 and bone scintigraphy in the follow-up of breast cancer.

By means of the retrospective study of the clinical records of 158 women followed for breast cancer, we aimed to evaluate the consequences of a non-systematic indication for bone scan (BS) based either on CA 15-3 levels alone or a combination of tumor marker levels and clinical criteria. With the first option, the negative predictive value was 95% and 82% of the BS would have been avoided. With the second option, the negative predictive value was 97% and 59% of the BS would have been avoided. Furthermore, the preliminary results of a longitudinal study showed that those patients with normal CA 15-3 levels and positive bone scans showed a subsequent rise in CA 15-3 levels which frequently became elevated with a average delay of 15 months. Omission of systematic bone scans in the follow-up of breast cancer patients is likely to lead to a delay in the diagnosis of bone metastasis in 3% to 5%, the consequences of which have to be examined carefully.

[Tracheotomy complications in resuscitation patients]. / Complications de la tracheotomie chez les malades de reanimation.

Many statistics on what concerned the tracheotomy complications are old, dating from 1960-1970, and discouraging to practise this kind of gesture. Moreover, it is unfeasible to objectively evaluate this technique from these huge sets where it is often difficult to separate the dramatic complications (massive haemorrhage, suffocating pneumothorax,...) and those more benign. The authors analyze through a retrospective study of 32 tracheotomised patients, the index of these complications in distinguishing those of the early stage and the late stage can occur even after decannulation. In the acute phase, haemorrhages 9.3 p 100) per inadequate haematosis, the pneumothorax (3.1 p 100) and the infection of the stoma (12.5 p 100) are the most frequent. The opening tracheotomy infection can support pulmonary infections (28.1 p 100) which cause serious problems at tracheotomised. After decannulation, the principal complication is the tracheobronchial stenosis (3.1 p 100). Its diagnosis is difficult and should be done by systematic endoscopic control of the trachea and radiological explorations at the time of the decannulation. The authors insist on the use of proper equipments, protocols of rigorous care and strict post-operative monitoring.