Impact of screening mammography and change in surgeons' attitudes on the pattern of primary care of breast cancer at a community hospital.

To gauge the impact of screening mammography and opinions regarding surgical procedures on the pattern of primary surgical care of breast cancer, tumor registry statistics from 1980-81 were compared to those from 1987 at a large community hospital. Over the course of six years, there was a significant increase in the proportion of patients with smaller tumors. Breast-conserving procedures increased from 8% to 39% of all therapeutic surgery. However, there was no change in the stage of the tumor at presentation because of an atypically low incidence of nodal involvement in 1980-81.

Chemotherapy of recurrent esthesioneuroblastoma. Case report and review of the literature.

Esthesioneuroblastoma is a rare epithelial tumor of the nasal olfactory mucosa. Its clinical course is characterized by indolent growth and persistent local recurrence and occasional distant metastases despite attempts at cure. Our report documents the response of a patient to a cisplatin-based drug combination and reviews the English-language literature of 25 patients treated with chemotherapy. We conclude that this tumor is sensitive to several different combinations and suggest guidelines for the use of chemotherapy in advanced or metastatic esthesioneuroblastoma.

Thrombocytopenia in homosexual men.

The office records of two private practices with a preponderance of homosexual patients were reviewed for cases of males with unexplained thrombocytopenia. Twenty-five patients meeting the selection criteria were found. The clinical and laboratory features of these patients were reviewed and compared to those characteristically seen in classic autoimmune thrombocytopenic purpura. The mean age of the group was 36.5 years. There was a high incidence of a history of sexually transmitted diseases. Sixty percent had another hematologic abnormality in addition to thrombocytopenia. The clinical outcomes for these 25 patients were as follows: eight (32%) had a spontaneous increase in platelets; four (16%) had a stable count not requiring therapy; 12 (48%) received high-dose prednisone; seven (28%) failed prednisone therapy and went on to splenectomy; two (8%) subsequently developed CDC-defined AIDS.

Proximal tubulare dysfunction associated with Burkitt's lymphoma.

Generalized aminoaciduria, uricosuria, glycosuria and phosphaturia were discovered in a patient with advanced Burkitt's lymphoma with renal infiltration. The literature is reviewed and three pathogenetic mechanisms are discussed. It is presumed that proximal tubular dysfunction in this case was related to the marked peritubular infiltrate causing cell mediated immunological injury or direct tubular destruction by tumor.

Bleeding, salicylates, and prolonged prothrombin time: three case reports and a review of the literature.

Fourteen cases of ASA induced hypoprothrombinemic bleeding, including three patients reported by the authors, are reviewed. Predisposing factors toward bleeding include malnutrition and malabsorption syndrome. Although the bleeding is usually benign, it may be serious on occasion. The importance of this rarely considered cause of ASA associated bleeding lies in the fact that it is readily corrected with Vitamin K.