Evaluation of the effect of breast cancer screening by record linkage with the cancer registry, The Netherlands.

OBJECTIVE: To evaluate the effect of a breast cancer screening programme by record linkage with the cancer registry. SETTING: Breast cancer screening programme in mid- and southern Limburg, the Netherlands. METHODS: The data files of the breast cancer screening programme and the Maastricht Cancer Registry were linked in order to evaluate the effect of breast cancer screening. Only the first primary breast tumour was included in the evaluation. RESULTS: From 1990 until 1995 90 001 women participated in the first round of the breast cancer screening programme and 64 637 in subsequent rounds. After the introduction of screening the annual number of breast cancer diagnoses increased by almost 50%. The incidence decreased to previous levels after completion of the first screening round. Record linkage detected 219 interval cancers (within two and a half years of a screening), a proportionate incidence of 31% in the first year and 60% in the second year of the two-year interval between screenings. The incidence of node positive breast cancer was 1% lower in 1994 and 15% lower in 1995 than the incidence in the period 1987-90. CONCLUSIONS: Evaluation of the effect of breast cancer screening in the Netherlands can be performed using routinely available cancer registry data. The results of this evaluation seem promising, but further studies are necessary to find ways to reduce the incidence of interval cancer.

A rare complication of implanted central-venous access devices: catheter fracture and embolization.

Totally implanted central-venous access devices are frequently used for the administration of chemotherapy or parenteral nutrition. Catheter fracture is a rare complication of these devices, with an estimated rate of 0.1%. We have lately seen three cases of catheter fracture with embolization of a catheter fragment to the heart and pulmonary vessels. These cases are described in this article. Catheter fracture is caused by intermittent compression of the catheter between the clavicula and the first rib, which can occur when the catheter has been inserted too far medially. When, on an X-ray of the chest, the catheter is shown to be compressed at the point where the clavicula crosses the first rib, or when infusion through the device suddenly becomes difficult, the chance of catheter fracture is high and the device should be removed.

Gastric epithelial atypia complicating hepatic arterial infusion chemotherapy.

Severe gastric lesions developed in five patients during hepatic arterial infusion chemotherapy employing 5-fluorouracil plus either leucovorin or mitomycin C. Ulceration with marked epithelial atypia was observed with striking structural distortion and cellular pleomorphism of the affected gastric mucosa. These features should be considered to be a complication of such treatment and should not be misinterpreted as malignancy.

Phase II study of hepatic artery infusion with 5-fluorouracil, adriamycin, and mitomycin C (FAM) in liver metastases from colorectal carcinoma.

Twenty-seven patients with liver metastases from colorectal carcinoma were treated with 5-fluorouracil, adriamycin, and mitomycin C (FAM) by hepatic artery infusion (HAI) every 2-3 months for a maximum of eight courses. Median survival for all patients was 22 months. Toxicity was acceptable and consisted in severe myelosuppression (8%), duodenal ulceration (8%), moderate nausea and vomiting (50%), and alopecia (100%). HAI with FAM is feasible and may have an impact on survival. Further studies are needed to determine the role of HAI, which may be of potential benefit to a substantial number of patients with metastatic colorectal carcinoma.

[The diagnosis of pulmonary calcinosis by scintigraphy (author's transl)]. / Die Diagnostik der Calcinosis pulmonis durch szintigraphische Untersuchungen

Three patients are described who were examined with the bone-seeking substance 99mTc-E.H.D.P. The abnormalities discovered were ascribed to metastatic calcification in the lungs. The patients suffered from three quite different conditions, but in each there was hypercalcaemia. One patient had chronic renal insufficiency with secondary hyperparathyroidism, in the other cases the cause of the hypercalcaemia could not be determined. In one patient, it was possible to confirm the diagnosis of pulmonary calcinosis histologically. Previously published cases indicate that it is possible to demonstrate lung calcification by using Tc-phosphate compounds, particularly 99mTc-E.H.D.P. This is important, since it is often not possible to demonstrate it radiologically. It further demonstrates that the accumulation of 99mTc-E.H.D.P. is dependent on active bone metabolism.

Congenital generalized fibromatosis: a case report with roentgen manifestations of the skeleton.

Congenital generalized fibromatosis is a rare disease. Since the features were described in 1954, 23 cases have been mentioned in the literature. 4 cases that had been reported before that time may retrospectively be said to belong to this syndrome. Congenital generalized fibromatosis resembles clinically as well as roentgenologically neurofibromatosis and may therefore be classified as a hamartomatosis, although the histological distinction of the congenital fibrosarcoma may sometimes be difficult. In this case report, a young patient is described with clinical, roentgenological and histological features of congenital generalized fibromatosis.

Radiology of carcinoid tumours of the small intestine.

Carcinoid tumors of the small intestine are particularly known in the literature for their hormonal activity and for the carcinoid syndrome caused by the serotonin they produce. The radiological symptoms are based, not only on changes caused by the tumour itself but also on changes induced by hormonal products in the intestinal wall and mesentery. The classical excentric intramural defect in the contrast column is therefore often accompanied by swollen mucosal folds, swelling of the intestinal wall and evidence of mesenteric retraction.

Extramedullary hematopoiesis in the posterior mediastinum.

Intrathoracic extramedullary hematopoiesis is a rare finding seen in some cases of chronic hemolytic anemia. A case of a 56-year-old man with congenital spherocytosis and characteristic lobulated masses in the posterior mediastinum, considered to be ectopic hematopoietic tissue, is reported. Biopsy in such cases is not necessary and may be dangerous.