Buerger's disease or Buerger's syndrome? An analysis of 12 cases.

Controversy continues over the clinical concept of Buerger's disease. Although clinical and radiological criteria exist to prove the diagnosis and most clinicians acknowledge this disease, there is the question of possible cases of Buerger's disease where the criteria cannot be met. Should these cases be referred to as Buerger's syndrome? In order to elucidate this question, we analysed 12 recent cases (1% of all our cases of vascular disease). In 6 cases (50%) the clinical and diagnostic criteria of Buerger's disease were met fully; in 4 (32%) the clinical picture favoured Buerger's syndrome; in another 2 patients the clinical picture was that of Buerger's syndrome but the arteriograms showed signs of atheroma. Eight of the 12 patients underwent sympathectomy. One patient, considered to have visceral and cerebral involvement, died.

Juvenile gastrointestinal polyposis or the infantile Cronkhite-Canada syndrome.

This is a report of a case of juvenile gastrointestinal polyposis consisting of widespread juvenile polyps encountered from the stomach into the rectum. Only few cases have been reported, and extra intestinal manifestations include clubbing of fingers, macrocephaly, hypotonia, hepatosplenomegaly, anemia, and protein-losing enteropathy. The outcome is usually dismal, the children barely becoming older than 2 years. Modern fibreoptic endoscopy with polypectomies performed via the upper and lower gastrointestinal intestinal tracts and via a midbowel ileostomy may offer a viable form of management.

[The dangers of mammography in diagnosing a palpable lump in the breast]. / Die gevare van mammografie in die diagnose van 'n tasbare knop in die bors.

The success of mammography screening programmes in the detection of unsuspected and impalpable breast cancer has led to reliance on a negative mammographic report as assurance that no malignancy is present even in palpable breast lumps. Pre-operative mammography was performed on 38 patients with palpable lumps who were subsequently proven by histology to have carcinoma of the breast. In 4 patients (10.8%) the mammogram was negative; 3 were also assessed as benign clinically. In 5 cases (13.5%) the report was negative but biopsy was recommended; 3 of the 5 were assessed as benign clinically. Therefore, in 9 of the 38 patients (24%) malignancy was not diagnosed unequivocally on mammography, although 3 of these patients had clinical stigmata of malignancy. Twenty-nine patients (76%) were diagnosed correctly by mammography; 5 of these cases were assessed as benign clinically. Six of the 38 cases (16%) were thought to be benign on both mammography and clinical examination. Thus, even confirmation by mammography that a breast lump without clinical signs of malignancy is indeed benign, does not rule out the possibility of carcinoma.