Angiosarcoma of the breast: A case report

The exact local prevalence of angiosarcoma of the breast is unknown. The challenge in pinning down the incidence is due it its rarity and possible difficulty in diagnosis since it may mimic other benign breast disorders. We are reporting a case of a 21-year-old female Filipino patient who presented with a 2cm x 2cm palpable mass on the upper outer quadrant of her right breast initially diagnosed through cytology as hemangioma and was later found out to have angiosarcoma of the breast after mastectomy. This is to illustrate the clinical presentation, methods of diagnosis, surgical management, and consequently better understanding of this clinical entity.

Sonographically-guided percutaneous needle aspiration of breast abscesses

BACKGROUND: Breast abscess can be treated by needle aspiration and ultrasound can facilitate its complete drainage.OBJECTIVE: To assess ultrasonographically guided needle aspiration of breast abscesses as an alternative approach after failed initial blind aspiration.METHODS: Twenty consecutive lactating and non lactating women who were initially aspirated for breast abscess were examined with ultrasonography. Abscesses depicted at ultrasound were treated with ultrasonographic guidance, and the success of ultrasound-guided treatment was prospectively determined.RESULTS: Twenty breast abscesses were identified at ultrasound; all were treated with ultrasound guidance: One patient who was treated subsequently underwent surgical intervention; all others were successfully treated with ultrasound intervention.CONCLUSION: This case series demonstrates that sonographically guided percutaneous aspiration of breast abscesses appears to be a promising alternative to surgical incision and drainage. Its advantages include its cure rate, simplicity and apparently good cosmetic result.

Effect of parenteral analgesic administration in clinical monitoring, diagnostic accuracy and outcome of patients with acute appendicitis

OBJECTIVE: To determine whether administration of parenteral analgesic affects clinical monitoring, diagnostic accuracy and outcome of patients with suspected acute appendicitis.METHODS: Prospective, double-blind, placebo-controlled administration of tramadol and normal saline (NS). Patients 11 to 65 years old with abdominal pain for less than seven days, with possibility of acute appendicitis and needing clinical monitoring for detinitive diagnosis, were included. Changes in abdominal physical examination findings and pain response were evaluated 30 minutes after administration of tramadol and placebo which were given right after initial assessment. Accuracy in diagnosis, appendiceal perforation rate, and morbidity and mortality rates were the outcome measures.RESULTS: One hundred sixty-three patients were enrolled. Eighty-four patients received tramadol (Grp 1) and 79 received NS (Grp 2). Seven patients, 5 in Grp 1 and 2 in Grp 2, did not undergo an operation because of nonsurgical diagnoses which were verified to be accurate during follow-up. One hundred fifty-six patients, 79 in Grp 1 and 77 in Grp 2, were admitted with a diagnosis of acute appendicitis and underwent surgery. There was no significant difference between the groups when comparing the accuracy of preoperative diagnosis and outcome of appendectomy in terms of perforation, morbidity, and mortality rates. In those receiving parenteral analgesics, there was significant pain reliefCONCLUSION: When compared with saline placebo, the administration of a parenteral analgesic (tramadol) to patients being monitored for possible acute appendicitis effectively relieved pain and did not alter the ability of the surgeons to accurately evaluate such patients.

A look at utilization and cancer detection yield of mammography

BACKGROUND: In the Philippines, mammography is frequently requested in the evaluation of patients with breast cancer concern. OBJECTIVES: The general objective was to take a look at the practice of requesting for a mammography in a health care institution and its outcome in terms of cancer detection in patients with non- palpable breast masses. METHODS: A retrospective review of past records from 1994 to 2001 was accomplished. RESULTS: A total of 7,323 mammog-raphies. 192 (3 percent) were done in the 20-29 age group; 966 (13 percent) in 30-39 age group; 2708 (37 percent) in 40-49 age group, 2410 (33 percent) in 50-59 age group and the remaining 1047 (14 percent) in those older than 60 years old. The top three physicians requesting for mammography were obstetrician-gynecologists, 2337 (32 percent); general surgeons, 1348 (18 percent) and internists and family medicine specialists, 806 (10 percent). Normal findings were reported in 4449 (61 percent); benign in 2721 (37 percent), suspicious for cancer without a clinically palpable mass in 99 (1.35 percent) and suspicious for cancer with a palpable breast mass in 52 patients (0.74 percent). A total of 50 patients underwent needle localization biopsy of which 35 had fibrocystic changes (70 percent), 10 had cancer (20 percent) and 5 with indefinite results. CONCLUSION: The overall cancer detection yield for mammography in those without a palpable breast mass, 7271 (7323-52) persons, was extrapolated to be 0.28 percent (20/7271). The authors deemed the information obtained in this study would be useful to the public, health care administrators and health care providers in reviewing the indication and cost-effectiveness of mammography.

Tetanus in necrotic soft tissue sarcoma of the lower extremity

This is a case of a Filipino patient with necrotic soft tissue sarcoma (fibrosarcoma) on the thigh that developed tetanus. This case report intends to instill awareness that tetanus can occur in tumors and not just in traumatic wounds. Literature search was made obtaining no local reports and foreign literature showed that though uncommon, tetanus could occur in tumors, especially in those that developed necrosis. Recommended preventive measures include early treatment of the tumor before necrosis sets in and if necrosis has occurred,early treatment, usually by surgical extirpation and anti-tetanus prophylaxis.