[Pleural effusion as a first sign of Ig D lambda multiple myeloma]. / Epanchement pleural révélateur d'un myélome à Ig D lambda.

Immunoglobulin D (IgD) multiple myeloma is rare, accounting for less than 2% of all patients with multiple myeloma. The main presenting features are bone pain in 70% of patients. Extramedullary involvement is less common. We report a case of Ig D lambda multiple myeloma in a 74-year-old man that was revealed by pleural effusion and dyspnea. This effusion was found to be caused by multiple myeloma after electrophoretic and cytologic assays. The patient received a course of chemotherapy with melphalan and prednisone. The patient died one month later with signs of septic shock. Pleural effusion as a first sign of Ig D multiple myeloma is rarely described and the prognosis associated with such a localisation is very poor.

Axillary padding as an alternative to closed suction drain for ambulatory axillary lymphadenectomy: a prospective cohort of 207 patients with early breast cancer.

HYPOTHESIS: Axillary lymphadenectomy performed without the use of a drain but with padding of the axilla is feasible and safe on an outpatient basis in the setting of conservative surgery for breast cancer. DESIGN: Prospective clinical study. SETTING: Public oncology center. PATIENTS: Two hundred seven patients were treated in our oncology center between January 11 and December 28, 1999, by means of this method of axillary lymphadenectomy based on axillary padding without a drain. One-day surgery was offered to each patient. INTERVENTION: At the end of each functional axillary lymphadenectomy, the axilla was padded with the use of axillary aponeurosis and local muscles. Axillary suction drains were not used at all in this series of patients. MAIN OUTCOME MEASURES: Prospective assessment was performed, without randomization, with regard to the length of hospital stay, the reasons for postoperative conversion from 1-day surgery to traditional hospitalization, and postoperative complications. RESULTS: Eighty-seven (42.0%) of the 207 patients underwent a 1-day procedure. In the 1-day surgery group, 87 (84.5%) of the 103 patients benefited from a true 1-day surgery procedure. The main reasons for conversion were nausea and anxiety rather than surgical complications. Hospital stay never exceeded 3 days. The most common postoperative complication was axillary seroma, with an average incidence of 22.2%. CONCLUSION: Breast-preserving surgery with axillary lymphadenectomy and padding of the axilla, precluding the use of a drain, is feasible and safe on a 1-day surgery basis for selected consenting patients.