Locally advanced and metastatic breast cancer in a tertiary hospital.

INTRODUCTION: The breast cancer incidence among Singapore women has risen through the years and is now the highest in Asia. Despite efforts to promote a greater awareness of breast cancer among the public, a significant number of patients still present with locally advanced or metastatic breast cancer. Our study aims to evaluate the clinical and pathological characteristics between patients presenting with locally advanced (LABC) and metastatic breast cancer (MBC) and those presenting with early breast cancer (EBC), to identify factors that predict for advanced disease. MATERIALS AND METHODS: We reviewed 622 patients who were newly diagnosed with invasive breast cancer in our department over a 4-year period from January 2000 to December 2003. Patient and tumour characteristics including age, parity, family history, tumour size and histology, grade and hormonal receptor status were analysed. Comparisons were made between those with EBC and those with LABC and MBC, as well as between Malay women and women of other ethnic groups. RESULTS: One hundred and thirty-four patients (21.5%) presented with either LABC or MBC. Adjusted analysis found that these patients were older and more likely to be nulliparous than those with EBC. Older patients tend to have larger tumours, but otherwise, age and parity did not correlate with tumour histology, grade or hormonal status. It was noted that Malay women, who were more likely to present with LABC or MBC, were more likely to have oestrogen receptor- and progesterone receptor-negative tumours. CONCLUSIONS: Older women and those who were nulliparous were found more likely to present with LABC and MBC. However, age and parity did not appear to be related to tumour histology, grade and hormonal status. Given that tumour size and stage have the greatest impact on overall survival, efforts to raise public awareness of the benefits of early detection and treatment should be continued, and possibly directed towards these groups of women who appear to be at an increased risk of presenting late.

Localization of TMJ sounds to side.

Differential diagnosis depends in cases with disk displacement on accurate identification of sound source. Mistakes may occur when clicking from one temporomandibular joint (TMJ) is heard on both sides of the head at auscultation and neither examiner nor patient, is sure about side. The hypothesis was that the head tissues affect spectral characteristics of TMJ sounds and that differences due to different positioning of sensors can be used in localization of source. The aim was to compare bilateral electronic recordings of unilateral TMJ sounds to obtain and compare attenuation, phase shift and time delay. Recordings were made from 12 subjects with unilateral clicking. Small electret condenser microphones, bandwidth 40-20 000 Hz, were placed at the openings of the auditory canals and the sounds were recorded at a sampling rate of 48 000 Hz. The head tissues acted as a filter causing a frequency dependent attenuation and phase shift. There was a time difference between the ipsi- and the contra lateral recordings, the latter always having a longer delay time (range 0.2-1.2 ms, group mean 0.68 ms, s.d. 0.292 ms). In conclusion, spectral analysis of bilateral electronic TMJ sound recordings is of diagnostic value when bilateral clicking is heard at auscultation and can help to avoid diagnosing a silent joint as clicking.

Skin stapled bowel anastomosis in a canine model.

AIM OF STUDY: The aim of this study is to compare the safety and cost effectiveness of the use of staples designed for skin closure in the construction of colonic anastomoses. METHOD: Twenty healthy dogs were prospectively randomised to either skin stapled or sutured anastomosis. The ascending colon was transected and reanastomosed. This segment was excised and used to test early bursting strength. There was no significant difference between the two groups. The ends of the colon were reanastomosed. RESULTS: The time taken to perform the anastomosis and the cost of the suture or staples were noted. The time taken for the stapled anastomosis was significantly faster (p < 0.001) with a mean of 7.95 minutes versus a mean of 23.5 minutes for the handsewn anastomosis. The cost was also significantly less (p = 0.18) with a mean of SGD17.85 compared to a mean of SGD21.15 for the handsewn anastomosis. Two weeks later, the dogs were sacrificed and the late bursting pressures were tested and no significant difference was found between the two groups. The anastomotic site was then sent for histological examination. The four animals, one in the handsewn group and 3 in the skin stapled group, dying prior to sacrifice, were subjected to post-mortem. CONCLUSION: The results show that skin stapled anastomoses are easy to learn and perform and may constitute a viable alternative to hand suture techniques.

Hypopituitarism following head injury--a case report.

A 16 year-old boy sustained fracture of the floor of the right orbital fossa in a road traffic accident with resultant diplopia and right enophthalmos. Symptoms of hypocortisolism subsequently developed. About two years after the trauma, pubertal changes which had occurred at 13-14 years had completely regressed. Endocrine testings confirmed clinical anterior hypopituitarism. Post-traumatic hypopituitarism may follow injury to the hypothalamus, the pituitary stalk or the pituitary itself. The normal thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) in this patient is in favour of a hypothalamic lesion. The patient has responded to replacement hormonal therapy.