Ductal carcinoma in-situ, cystic hypersecretory type presented by recurrent hemorrhagic cyst.

Recurrent hemorrhagic cyst is an uncommon presentation of breast disease. The ordinary imaging could not demonstrate the malignant features of the cyst. However, the non-contrast dedicated breast computerized tomography could support the malignancy concern. Although tissue diagnosis cannot show the malignant cell, Surgical excision could be offered without uncompromising. Eventually, ductal carcinoma in-situ was diagnosed and further adjuvant treatment could be given. We reported the first case report of ductal carcinoma in-situ, hypersecretory type, presented by a hemorrhagic cyst.

Preoperative radiation in large angiomatosis of the breast, attempting breast conserving surgery: multidisciplinary approach.

Angiomatosis of the breast is very rare. The presentations are including breast mass, skin discoloration and breast enlargement that mimic to angiosarcoma. The imaging could suggest non-specific vascular tumors. The histology should be obtained for the certain diagnosis. Surgical excision is the standard treatment. To our knowledge, this is the first case that preoperative radiation is given. Currently, radiation is occasionally used in benign condition. This case shows the successful result of preoperative radiation for achieving breast conserving surgery in large angiomatosis of the breast.

Surgery of the abdominal aorta: experience of a university hospital in Thailand.

One hundred and thirty two patients who underwent aortic surgery at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000 were studied. Twenty three patients (17.4%) were aged less than 60 years, 102 (77.3%) aged 60-80 years, and 7 (5.3%) were older than 80 years. Ninety eight patients (74.2%) underwent elective operations and 34 (25.8%) underwent emergency operations. Elective abdominal aortic aneurysms (AAA) repair was the most common indication for abdominal aortic surgery (56.0%). Eighteen patients (13.6%) underwent surgery for infected AAA. The incidence of infected AAA was 16.1 per cent among patients with AAA. Fifteen patients (11.4%) had ruptured AAA and 19 patients (14.4%) had aortoiliac occlusive disease. The overall mortality rate was 15.2 per cent. The mortality of elective aortic surgery was 5.1 per cent and of emergency aortic surgery was 44.1 per cent. The mortality of elective AAA repair was 4 per cent. Multiple system organ failure was the most common cause of death (80%), followed by acute myocardial infarction (10%) and exsanguination (10%). The authors conclude that elective surgery on the abdominal aorta is safe and should be performed when indicated to prevent the development of complications requiring emergency surgery which carries a much higher risk.

Exercise training for intermittent claudication: does it adversely affect biochemical markers of the exercise-induced inflammatory response?

OBJECTIVES: To identify a stable biochemical marker of disease severity in patients with intermittent claudication and to use these findings to assess the effect of therapeutic exercise training. DESIGN: Case-control study: prospective randomised-controlled trial of exercise training. MATERIALS AND METHODS: Plasma fibrinogen, serum amyloid A protein (SAA), C-reactive protein (CRP) and urinary albumin-creatinine ratio (ACR) were measured in 67 claudicants and 15 controls. Twenty-two patients were randomised to supervised exercise training and 17 randomised to observation. Subjects were reviewed at 3, 6 and 12 months. RESULTS: The median (interquartile range) baseline fibrinogen was 3.7 g/l (3.3-4.25) in claudicants and 3.5 g/l (2.9-3.95) in controls (p = 0.045); CRP was 4.7 mg/l (2.2-9.0) and 2.1 mg/l (1.0-2.8), respectively (p < 0.0001); SAA was 72 mg/l (35-132) and 30 mg/l (20-89) (p = 0.0009). Claudicants showed an increased urinary ACR following treadmill exercise (Wilcoxon, p < 0.0001) with no change in controls. Exercise training reduced SAA at 6 months, CRP at 3 months and progressively attenuated the post-exercise increase in ACR. No similar changes were found in controls. CONCLUSIONS: Repetitive low-grade inflammatory events in claudicants lead to elevation of serum acute-phase proteins. Exercise training is associated with symptomatic improvement and reduction inflammatory markers. The concern that exercise has adverse systemic effects therefore seems to be unjustified.