Prolonged complete response after neoadjuvant capecitabine-gemcitabine for a locally advanced pancreatic adenocarcinoma: A case report.

Background: Pancreatic duct adenocarcinoma is increasing in incidence without appreciable decrease in overall survival despite decades of heightened research. Its mortality rate approaches its incidence rate. We report a case of carcinoma of the pancreas that had complete response from adjuvant chemotherapy. Case Presentation: A 39-year old male radiographer presented with a 3-month history of progressively worsening epigastric pain radiating to the back, associated with history of weight loss, anorexia, and jaundice. Abdominal CT scan showed a mass in the head of pancreas. A Whipple's operation was planned for the patient. However, intraoperatively, the head and body of the pancreas were found to have been taken over by the tumor, which encased the portal vein as well. Multiple core needle biopsies of the pancreas were taken. Cholecystojejunostomy, gastrojejunostomy, and jejunojejunostomy were then done. Histopathologic analysis of the specimen revealed a well-differentiated adenocarcinoma of the pancreas. He was commenced on 28-day cycle of gemcitabine 1000 mg/m2 on Days 1, 8, and 15 plus capecitabine 830 mg/m2 on Days 1-14. Repeat CT scan done after the 4th cycle showed no residual tumor in the pancreas. He has been in good health after 36 months follow-up, having received eight cycles of chemotherapy. He was counseled on resection of the pancreas, but he declined. Conclusion: Complete radiologic response may rarely occur after adjuvant chemotherapy for locally advanced adenocarcinoma of the pancreas. This does not, however, imply a cure of the disease.

Breast reduction surgery in the UK and Ireland - current trends.

INTRODUCTION: This paper reviews the current status of bilateral breast reduction surgery in the UK and Ireland. It examines the pre-operative, operative and postoperative management of women. PATIENTS AND METHODS: A questionnaire established information about surgeons' experience, bilateral breast reduction work-load, pre-operative assessment, selection criteria, issues of operative technique and postoperative management. This was sent to 230 consultant plastic surgeons working in the NHS in the UK and Ireland. RESULTS: There was a 61% response rate. Of respondent surgeons, 82% always perform pre-operative photography, 71% never do a mammogram even in patients above the age of 50 years. Body mass index (BMI) is the most commonly used criteria for patient selection (60%). Two-thirds of the surgeons use an inferior pedicle technique and 75% of surgeons work in health authorities that restrict breast reduction surgery. CONCLUSIONS: There was significant variation in practice among surgeons performing bilateral breast reduction. This may reflect a lack of evidence base for practise. Published literature focuses almost exclusively on the description of different techniques. Further work is required to evaluate the role of pre-operative mammography, specimen mammography, antibiotics and selection criteria for surgery.

Effects of bilateral breast reduction on anxiety and depression: results of a prospective randomised trial.

We assessed the effects of bilateral breast reduction on anxiety and depression in women with mammary hypertrophy (macromastia). Seventy-three consecutive women referred for consideration for breast reduction were recruited. They were randomised to have either early operation (within six weeks of initial assessment) or delayed operation (within six months of recruitment). The Hospital Anxiety and Depression Score was given before randomisation and four months later. All 73 patients completed the study. The mean (SD) age was 39 (12) years. The groups were matched for age, smoking, social class, and educational achievement. There were highly significant improvements (p<0.001) in symptoms of anxiety and depression. Reduction mammaplasty significantly improved symptoms of clinical depression in women with macromastia.

Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.

BACKGROUND: The aim was to determine the effects of bilateral reduction mammaplasty on quality of life and psychosocial functioning in women with mammary hypertrophy. METHODS: Seventy-three women who were referred to either the Hull Breast Unit or Hull Plastic and Reconstructive Surgery Unit were randomized to early or delayed surgery. Both groups had quality of life and psychosocial assessment. Each group underwent two sets of tests. Women who had early bilateral breast reduction were tested before and at 4 months after surgery, whereas those in the control group were tested at the time of randomization and 4 months later, before undergoing surgery. RESULTS: All 73 women completed the study. Mean age was 39 years, and the two groups were well matched for age, body mass index and breast dimension. There were highly significant differences between groups in scores measured on the Functional Assessment of Non-Life Threatening Conditions version 4, EuroQoL, and both mental and physical scales of Short Form 36 (P < 0.001). The Eysenck Personality Questionnaire-Revised demonstrated a statistically significant increase in extroversion and emotional stability in the early treatment group. CONCLUSION: Reduction mammaplasty significantly improved quality of life, and increased extroversion and emotional stability.

Primary carcinoma of the appendix - Hull series.

BACKGROUND: Appendiceal carcinoma (AC) is a rare entity that does not have a well-defined treatment strategy. At presentation, most patients are clinically thought to have appendicitis and the diagnosis is made only by formal histology. Once the diagnosis of AC is made, patients are treated by various strategies including surgery, chemotherapy depending on nodal status of the disease. AIM: To review the Hull hospitals' experience with AC. METHODS: Between 1982 and 2002, 10 patients with primary AC were seen. The histopathology reports of all appendiceal specimens removed were traced. Follow-up was by chart review or patient follow-up as appropriate. We did not include patients with primary carcinoid tumours or secondary adenocarcinoma. RESULTS: There was an equal sex distribution. All patients underwent surgery, 3 had post-operative chemotherapy. Complete follow-up information was available with a median follow-up time of 56 months, with a range of 12-168 months. Five patients survived at least 4 years from the time of diagnosis. CONCLUSION: Long-term survival in patients with AC is possible.

Deskinning versus deepithelialization for inferior pedicle reduction mammoplasty: a prospective comparative analysis.

BACKGROUND: Deepithelialization is time consuming, but has been performed traditionally in reduction mammaplasty to ensure a better blood supply to the transposed nipple-areolar complex. METHODS: For this study, 18 patients were recruited, and each patient served as an individual control by undergoing both deskinning and deepithelialization of the contralateral breast. The patient's age, body mass index, specimen weight, complications, and subjective cosmetic assessment were recorded. RESULTS: The mean age was 42 years, and the mean body mass index was 27.94 respectively. There were no differences recorded in terms of complications or patient perceived cosmetic outcomes. The only statistical difference involved the times required for deepithelialization (15.5 min) and deskinning (6 min). Deskinning thus saved approximately 9 min. CONCLUSIONS: Deskinning is as effective as deepithelialization and is significantly more expedient, with no added risk to the patient.

Pyomyositis mimicking right iliac fossa mass: review of the literature.

Pyomyositis is a pyogenic infection of skeletal muscle. Its incidence in temperate countries though low is rising. Most cases from the temperate region involve immuno-compromised patients. The onset is usually insidious with progression to large purulent collections. Because of its low incidence in temperate countries, it is often initially misdiagnosed. A high index of suspicion with appropriate imaging techniques, aggressive surgical intervention and adjunctive antibiotic therapy are the keys to prompt resolution. A case of pyomyositis mimicking right iliac fossa (RIF) mass is described with a review of the literature.