Phase II study on the use of intraoperative radiotherapy in early breast cancer

To report our early experience using the Intrabeam radiotherapy delivery system for intraoperative radiotherapy [IORT] in early breast cancer. This is a prospective phase 2 study carried out at the Department of Surgery and Radiology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from December 2010 to November 2012. Females eligible for breast-conserving surgery with biopsy-proven invasive duct carcinoma, and with a mass of 3 cm, with lymphovascular invasion, multifocal lesion, extensive intraductal carcinoma, and positive nodes. Early and late toxicity were recorded using the Radiation Therapy Oncology Group [RTOG] criteria. Forty-five patients were included with a median age of 54 [range: 27-79 years]. Thirty-six cases [80%] had tumor <3 cm in diameter, and 36 [67%] have pathologically negative axillary lymph node metastases. None of the patients developed delayed wound healing, postoperative infection requiring intravenous antibiotic, or breast seroma requiring aspiration. Sixteen [36%] received EBRT after IORT. Twelve patients developed radiologically proved fat necrosis. The IORT for early stage breast cancer patients using the Intrabeam delivery system was easily implemented in our center with an acceptable toxicity profile and cosmetic outcome

Isolated respiratory failure caused by myasthenia gravis

Isolated respiratory failure due to myasthenia gravis that selectively involved the respiratory muscles alone is extremely rare and difficult to diagnose. We reported herein, a 46 year old patient who presented with acute respiratory failure, 4 weeks after thymoma resection. The respiratory failure was due to myasthenia gravis that selectively affected the respiratory muscles only without having any peripheral signs. The initial response to therapy with pyridostigmine was unexpectedly complicated with severe bradycardia that made insertion of permanent pacemaker essential, before further therapy

Seminoma of an undescended testis presenting as incomplete large bowel obstruction

Seminoma is the most common neoplasm to arise in the undescended testicle. The clinical presentation of such a tumor is either as an abdominal mass or abdominal pain. A patient with a seminoma developing in an undescended testicle which presented as an incomplete large bowel obstruction is being reported. To our knowledge, such presentation has not been reported previously. The clinical presentation, investigations, treatment modalities, and long term follow-up result are described