Comparison of HER-2 overexpression in primary breast cancer and metastatic sites and its effect on biological targeting therapy of metastatic disease.

HER-2 overexpression, a predictive marker of tumour aggressiveness and responsiveness to therapy, occurs in 20-30% of breast cancer. Although breast cancer is a heterogeneous disease, HER-2 measurement is carried out in primary tumour. This study aims to evaluate HER-2 overexpression in primary and metastases and its effect on treatment decisions. Biopsies from primary breast cancer and corresponding metastases from 58 patients were studied. HER-2 overexpression was evaluated immunohistochemically in all primary and metastatic sites. Positive overexpression in primary and/or metastases was confirmed by fluorescence in situ hybridisation (FISH). Discordance in HER-2 overexpression between primary and metastatic sites was 14% (eight of 58 patients). Concordance was found in 50 (86%) of patients (95% CI: 77-95). In one patient (2%), HER-2 was negative in metastasis but positive in primary. In seven (12%) patients, HER-2 was positive in metastases and negative in primary (95% CI: 3.7-20), and three of them responded to trastuzumab. Gene amplification by FISH was found in all cases with HER-2 positive (+2 and +3) by immunohistochemistry. Our data suggest that a possible discordance of HER-2 overexpression between primary and metastases should be considered when making treatment decisions in patients with primary HER-2-negative tumours.

[Stromal tumors of gastrointestinal tract: clinical and pathological features].

During the period 1991 till 1999, ten patients with primary stromal tumors of the gastrointestinal tract (stomach, duodenum, jejunum, ileum and rectum) were treated. Nine patients underwent radical resection and one patient had non-complete resection of the tumor. The median age of the group was 63 years for 7 male and 3 female patients. The median follow-up period was 58 months. The tumor size was 4.5-17 cm. (median 10 cm.) The median survival was 43 months. Five patients remained alive without the disease (median survival 87 months). One patient died with no evidence of the disease after 12 months. One patient remains alive with liver metastases for 13 months and 4 patients died of metastatic disease (median survival 10 months). Features associated with decreased survival included tumor size > 5-8 cm., mitotic counts > 5 mitotic figures per 50 high-power microscopic fields and high cellularity.

[Idiopathic external hydrocephalus].

5 male children who had idiopathic external hydrocephalus are described; all were all in the first year of life. Macrocephaly and hypotonia were present in all, as well as mild to moderate delay in language and gross motor development; cognition was normal. CT-scan showed in all enlarged subarachnoid spaces but normal or mildly dilated lateral ventricles. Macrocephaly was present in the fathers of 4 of the 5 families. In all cases the course of this condition was benign. There was clinical and roentgenological improvement between the ages of 2 and 2.5 years; the developmental delay resolved at about age 4, at which time the CT pattern had become normal.

Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity.

Vertical banded gastroplasty (VBG) is today the most widely performed bariatric operation. The procedures used previously for the same purpose resulted in metabolic derangements and other pathologies during pregnancy. In a retrospective study we compared the reproductive performance of nine women prior to VBG and after it. Of eighteen pregnancies prior to the operation, seven ended with miscarriage, while only one of fourteen pregnancies conceived after the operation was aborted. The rate of spontaneous conception was greatly increased after the operation and there were fewer complications in the course of the pregnancies. From the obstetrician and gynecologist's point of view VBG seems to be a good treatment for morbid obesity.

Axillary vein thrombosis during pregnancy: a case report.

A 32-year-old multiparous woman had progressive swelling of the right arm at 32 weeks' gestation, accompanied by cyanosis and a preserved radial pulse. Phlebography demonstrated a 5-cm thrombus in the axillary vein. No known etiologic factors were found. Intravenous heparin administration resulted in rapid resolution of the clinical findings. Subcutaneous heparin 10,000 U/day was administered for secondary prophylaxis until cesarean at 39 weeks, during which a full dose was administered without complications. Axillary vein thrombosis during pregnancy may be diagnosed by either phlebography or duplex scanning, and preferably should be treated by heparin. Thrombolytic therapy is justified mainly for life-threatening complications such as pulmonary embolism.

Erosion of Marlex Mesh Collar after Vertical Banded Gastroplasty.

Marlex mesh, as opposed to silastic ring, when used as a collar in the bariatric procedure of vertical banded gastroplasty, has been reported rarely to erode into the gastric lumen. We report two cases of such an erosion, of which one ended as a complete internalization of the collar into the stomach. In one of the patients we observed a wider than expected portion of tissue that had been encircled by the collar, which might have caused a local inflammatory reaction leading to the later erosion.

Sudden dysphonia due to parathyroid apoplexy: a rare case of recurrent laryngeal nerve palsy.

A case is presented of sudden onset dysphonia in a 59-year-old man caused by acute vocal cord paralysis due to bleeding within a hyperplastic lower right parathyroid gland. There were no laboratory findings of hyperparathyroidism nor coagulation disorder. Acute onset of vocal cord paralysis is rarely associated with benign processes; the current case is the first associated with parathyroid hyperplasia.

Postoperative pain after inguinal herniorrhaphy with different types of anesthesia.

In a randomized, double-blind study, postoperative pain was assessed in 36 patients undergoing inguinal herniorrhaphy with three types of anesthesia: general (thiopental-nitrous oxide-halothane); general with the addition of local (infiltration of the abdominal wall with 0.25% bupivacaine along the line of the proposed incision); and spinal (0.5% bupivacaine). The severity of constant incisional pain, movement-associated incisional pain, and pain upon pressure applied to the surgical wound using an algometer was assessed with a visual analogue self-rating method at 24 h, 48 h, and 10 days after surgery. The addition of local anesthesia significantly decreased the intensity of all types of postoperative pain. This effect was especially evident with constant incisional pain that disappeared almost completely 24 h after surgery. With pain caused by pressure on the site of the surgical incision, the pain score difference between general and general plus local anesthesia was obvious even 10 days after the surgery (with 0.4-kg/cm2 pressure, the pain scores were 16 +/- 3 vs 2 +/- 1, P less than 0.01). The difference in postoperative pain scores between spinal and general anesthesia groups indicated that spinal anesthesia also decreases the pain intensity. However, this decrease is less pronounced than that seen with the addition of local anesthesia: movement-associated pain scores 24 h after surgery were 72 +/- 5 in the general anesthesia group, 40 +/- 6 in the spinal anesthesia group, and 16 +/- 3 in the general plus local anesthesia group (with P less than 0.002 between the groups).(ABSTRACT TRUNCATED AT 250 WORDS)

Posterior duodenal ulcer: acute free perforation into the lesser sac.

Perforation of a peptic ulcer located on the posterior wall of the duodenum is very rare. We present here three cases with acute and free perforation of a posterior duodenal ulcer with a fatal outcome. To the best of our knowledge such an acute free perforation has not been previously published.

Emergencies in delayed diaphragmatic herniation due to blunt trauma.

A transthoracic approach was used in the treatment of 2 patients with emergencies due to traumatic diaphragmatic hernia. Relevant symptoms began respectively 3 months and 8 months after closed injury. Strangulation and necrosis of abdominal organs herniated into the chest are associated with a high mortality. Awareness and early diagnosis will reduce mortality.