Periscapular amputation as treatment for brachial plexopathy secondary to recurrent breast carcinoma: a case series and review of the literature.

AIMS: Recurrent breast carcinoma with brachial plexus involvement is often misinterpreted as a radiation- or chemotherapy-induced brachial plexopathy. We review a case series of 4 patients at our institution within a 1-year period, and describe their diagnostic workup and treatment with a palliative periscapular amputation. Our aim is to describe this entity, indications and benefits of this procedure, when required for progressive disease, with the goal of raising a collective index of suspicion to aid in earlier diagnosis. METHODS: Four patients with recurrent axillary breast cancer and symptoms consistent with a brachial plexopathy were prospectively collected over a 1-year period. A Pubmed search was conducted; pertinent articles were reviewed and reported. RESULTS: Patients presented with intractable pain and flaccid paralysis of the ipsilateral limb. All had been previously treated with surgical resection, axillary lymph node dissection, chemotherapy, and radiation therapy. Average time from breast surgery to presentation was 78.75 months (range 11-216 months.) Workup included MRI and biopsy to confirm recurrence. Periscapular amputation was performed for each patient, all of who experienced subjective pain relief postoperatively. Three of the 4 patients are still living; one patient died of disease. CONCLUSION: Breast cancer survivors presenting with a brachial plexopathy should raise suspicion for recurrent disease. Close evaluation with MRI is the best first step in diagnosis. Although periscapular amputation is an aggressive surgical treatment, it is an acceptable option when disease has progressed to neurovascular involvement and a functionless limb.

Physalis angulata L. antineoplasic activity, in vitro, evaluation fromit's stems and fruit capsules

Physalis angulata L. (genus Physalis; family Solanaceae) is an herbaceous specimen that grows plentifully at North, Northeast and Middleast Brazilian's regions1. Its fruits are edible, roots and epigeal parts are taken as tea or infusion, all through the world as traditional medicine. Despite of this usefulness not much scientific work has been done on it. This research carried out with plant material (stems and fruit capsules) has the main aim to find out anti-neoplasic activity. The obtained results are described in Table 1. The most significant inhibition values are those for fruit capsules fractions such as 97 percent mouse lymphoma; 93 percent Erlich carcinoma strains when was assayed with MGTS-1-2ai and MGTS-1-1ai respectively. In the course on going studies on the biological response and chemical constituents of P. angulata some fractions were obtained from stems and fruit capsules ethanolic and methanolic extracts. The extract prepared from roots of P. angulata is the most clinically used by physicians for treatment of human hepatic disorders, despite the substance responsible for the efficacy still a matter of argument.