Comparison of clinicopathological characteristics and outcome of inflammatory and non-inflammatory locally advanced breast cancer: a study in Iran

Background: Inflammatory breast cancer [IBC], a subgroup of locally advanced breast cancer [LABC], is diagnosed based on clinical findings, and seems to be different from other types of LABC. The purpose of this study was to compare clinicopathological characteristics and outcomes between inflammatory and non-inflammatory LABC patients at Breast Cancer Research Center [BCRC], Tehran, Iran. Methods: The medical records of all patients who were diagnosed as LABC in BCRC since 1997 to 2011 were extracted from the database. Then, clinical and pathological characteristics and overall survival of IBC patients were compared with non-inflammatory LABC [NI-LABC]. Results: A total number of 340 patients were identified as LABC from which 17 patients [5%] were diagnosed as IBC. Menopausal status, body mass index [BMI], family history of breast cancer, nodal status, and Her2/neu and PR positivity were not statistically different between IBC and NI-LABC groups. The difference in estrogen receptor [ER] between the two groups was significant [P = 0.028]. Median duration of follow-up was 26.50 months. Patients with IBC had overall survival of 27.9 months [95% CI: 22.7–33.1] which was lower than patients in the NI-LABC group with a survival of 118.9 months [95% CI: 107.3–130.6] [P = 0.015]. The difference between the disease-free survivals of the two groups were also statistically significant [P < 0.001]. Conclusions: Compared to NI-LABC, IBC is more frequently ER negative and more commonly associated with lower survival rate. These findings reinforce the idea that IBC has a more aggressive biology and more unfavorable outcome than NI-LABC and needs close follow-up

Laparoscopic versus open appendectomy; which method to choose? a prospective randomized comparison

Appendicitis is the most common surgical emergency with the incidence rate of 6-10%. Although several studies have compared the two approaches of open [OA] and laparoscopic appendectomy [LA] the technique of choice is still a matter of controversy. Considering this background we designed a study to compare OA and LA outcomes in our center. One hundred patients were included in this study performed from April 2008 to April 2009 at Shahid Sadoughi hospital, Yazd, Iran. Patients who gave informed consent were randomized to either OA or LA groups and were operated by McBurney's or laparoscopic technique, respectively. Patients received our center's routine diet, antibiotics and analgesic regimens. The patients' pain was measured by visual analogue scale [VAS] at their entrance to the recovery room and in 6-hour intervals up to 24 hours. Post-operation follow up visits were in weeks 1, 2 and 4. The data of operation time, hospital stay, intra-operation complications, time to resume normal activity, short term complications and neuralgia were collected and analysed. The average operation time was 34.4 +/- 8.42 min in LA and 41.7 +/- 8.84 in OA hand [P=0001]. No intra-operative complication and no LA to OA conversion were encountered in operations. Post-operative complication rate was higher in OA group [n=10] compared to LA [n=3]. The post-operative pain showed less pain in OA only at 6 and 12 hours post-operative times. Patients' mean hospital stay was 52.32 +/- 19.2 and 42.96 +/- 13.8 hours in LA and OA groups, respectively [P=0.003]. Time to resume normal activity didn't show a significant difference between two groups [P=0.53]. Only one case of neuralgia in the OA group was confronted in the follow up visits. LA has less complications and cosmetic scar with the cost of more pain. Decision between OA and LA for each patient should be made individually