Is there any association between uterine malignant mixed Mullerian tumour, breast cancer and prolonged tamoxifen treatment?

Uterine malignant mixed Mullerian tumour is a very aggressive tumour of unknown aetiology. Previous pelvic irradiation, excessive oestrogen exposure, obesity and nulliparity have been incriminated in its aetiology. There is a paucity of data on the association between uterine mixed Mullerian tumour breast cancer and prolonged tamoxifen treatment. We report four patients who took tamoxifen for more than 7 years for breast cancer prior to their diagnosis with uterine mixed Mullerian tumour and also reviewed similar cases reported in the medical literature. The purpose of this article is to draw the attention of other professionals on this subject.

Analysis of urinary nucleosides. II. Comparison of mass spectrometric methods for the analysis of urinary nucleosides.

Qualitative and quantitative analyses of urinary nucleosides have diagnostic potential as tumour markers. We have developed separation techniques linked to mass spectrometric detection in order to overcome the problems associated with past identification and quantitation methods. The three methods of analysis utilised were: gas chromatography/mass spectrometry (GC/MS), high-performance liquid chromatography/ion-trap mass spectrometry (HPLC/ITMS) and capillary liquid chromatography/triple quadrupole mass spectrometry (CapLC/TQMS). Here we compare the relative effectiveness of each of the techniques for subsequent application in the systematic study of urinary nucleoside profiles in cancer patients. All three methods proved to be valuable techniques for such urinary nucleoside analyses, and a combination rather than one single choice is concluded as the ideal.

Pragmatic randomised trial to evaluate the use of patient held records for the continuing care of patients with cancer.

OBJECTIVE: To evaluate the use of a multidisciplinary record held by patients with cancer in the community. DESIGN: Pragmatic randomised controlled trial. SETTING: The environs of Swansea in south west Wales. PARTICIPANTS: 501 patients under the care of the Department of Oncology, Singleton Hospital, Swansea. INTERVENTION: A patient held record used by the patient and healthcare professionals. Main outcome measures-Health related quality of life (EORTC QLQ-C30) measured at entry into the study and at 6 months; patients' views at 6 months; healthcare professionals' views collected after the completion of patient follow up; NHS resource and booklet use. RESULTS: 1148 patients were eligible for the study; 501 were recruited (44%) and 344 completed the study (172 in each group). There was no significant difference between the two groups in change in quality of life or NHS resource use. The patient held record did not have an impact on communication but was significantly helpful to patients in preparing for appointments, reducing difficulties in monitoring their own progress, and helping them to feel more in control (p<0.05). Fifty three percent of patients would have preferred not to have a patient held record. There was a low level of use of the record by healthcare professionals but most of those who remembered using it indicated that they would prefer patients to have it. CONCLUSIONS: The patient held record is valued by some patients and professionals but has no significant impact on the quality of life of patients or NHS resource use. It has a positive impact on quality by helping patients feel more in control and prepare for meetings with healthcare staff. Patients who find it useful tend to be younger and have more professionals involved in their care. It is recommended that it should be made available to patients on request and used by them according to need.

Analysis of urinary nucleosides. I. Optimisation of high performance liquid chromatography/electrospray mass spectrometry.

In order to optimise the analysis of urinary nucleosides by high performance liquid chromatography/mass spectrometry (HPLC/MS), the HPLC separation of these compounds was performed at different 'flow rates' and 0.2mL/min was found to give both a better separation and ionisation. The ionisation conditions were optimised to give the best intensity of the molecules quasi-molecular ions. The ion distribution profile and ionisation in both positive and negative mode were examined and the detection of the protonated molecule in positive mode chosen for further analysis. The limits of detection of the method developed are reported and representative LC/MS and LC/MS/MS spectra shown. Typical urinary nucleoside chromatograms are presented.

Angiosarcoma of the head and neck.

Angiosarcoma of the head and neck is a rare tumour of vascular origin that affects the elderly. A 74-year-old man who presented with bruise-like macules of the scalp and face is reported. He was treated for a few months with different antibiotics and anti-allergic medication by his own family doctor, and referred for specialist opinion when he failed to derive any benefits from the medications. A biopsy was obtained from the lesion and proved to be an angiosarcoma. A review of the literature indicates that the most important prognostic factor in this particular disease is the size of the lesion on presentation, hence the importance of early diagnosis. This case is reported, and the literature for similar cases is reviewed, to highlight the diagnostic and therapeutic aspects of this uncommon aggressive tumour in an attempt to help in the process of early diagnosis.

Prostatic leiomyosarcoma: the case for combined modality therapy.

Patient. A 65-year old man who had previously undergone surgery for benign prostatic hyperplasia presented with symptoms of recurrent bladder outflow obstruction. Cystoscopy revealed the presence of recurrent tissue.Results. Histology identified a leiomyosarcoma. Several years after further surgery and radiotherapy, the patient presented with secondaries in the lungs and brain, but there was no evidence of local recurrence.Discussion. It is suggested that combined modality therapy (conservative surgical resection followed by adjuvant radical radiotherapy) be the initial treatment for prostatic leiomyosarcoma.

Prediction of stature from hand measurements.

A sample of 166 normal adult males and females was taken from different colleges of Assiut representing those living in upper Egypt. Each subject has been studied for measurements of stature (S), hand length (HL) and hand breadth (HB). The data were statistically analysed in order to assess the relationship between stature and hand measurements. The correlation matrix of the study indicates close similarity of the relationship between stature and hand measurements in both sexes and in both sides. A generalized multiple regression equation has been designed to estimate stature from values of hand length and hand breadth regardless of sex or side in the form: S = 34.5 + 5.77 HL + 2.7 HB +/- 5.1. This equation may be helpful to obtain approximate stature when there is difficulty in obtaining a direct measurement or where there is a chance print of a criminal or an amputated hand or arm.