Search

One hundred and four patients with bilateral breast cancers, detected clinically, were studied. Patients with synchronous lesions experienced the worst survival. Lymph node metastases in the second mastectomy had obvious adverse effect on survival. The development of scirrhous carcinoma in the second breast did not alter survival. A maximum of 21 patients might have been adversely affected by the development of a second cancer because of lymph node metastases in the second breast only. Survivorship data suggest the adequacy of treatment of contralateral breast cancers when they become detectable by clinical means alone.

Primary gastrointestinal carcinoid tumors rarely metastasize to the orbit, but an aggressive approach is warranted for any patient with a history of carcinoid tumor and ocular complaints. The diagnosis can be established only by obtaining tissue for histologic examination. Treatment, usually with radiation, can result in symptomatic improvement and should be considered after confirmation of the diagnosis.

A new human breast cancer cell line (Ia-270) has been isolated from a malignant pleural effusion from a woman with metastatic infiltrating ductal carcinoma of the breast. This cell line contains cytoplasmic estrogen (ER) and progesterone (PR) receptors. Following estradiol (E2) administration, PR synthesis is augmented and a higher level of saturation density is reached. In an athymic mouse, the cell line produced a tumor morphologically similar to the primary tumor. The results of isoenzyme and karyotype analyses demonstrate Ia-270 to be of human origin and free of HeLa cell contamination. The cell line has been maintained in continuous culture since April 1982 and may provide a useful in vitro system for studying the biology of human breast cancer.

The occurrence of bilateral breast cancers in three members of one family is reported. In two members, evidence of a distinct primary lesion in each breast was verified. The occurrence of unilateral breast cancer and other cancers in other members of the family was surveyed. Recommendations for early detection and surveillance in familial breast cancer at the present time should be by aggressive and close follow-up of the affected members. Absence of reliable markers preclude effective surveillance for early detection or susceptibility.

• The records of 916 trauma victims transported by an emergency helicopter service were reviewed to evaluate its impact on patient outcome. According to strict criteria, the service was classified as essential, helpful, or "not a factor" in the preservation of life and/or limb in each case. The helicopter service was essential in 14.0%, helpful in 12.9%, and "not a factor" in 56.6% of patients. A fourth category included patients who, despite the delivery of maximal emergency medical care, died as a result of their injuries (16.5%). With the available initial information, it was impossible to determine prospectively which patients would benefit from air transport. We believe that the rapid evaluation of potentially serious injuries and the number of patients for whom the service proved beneficial justify its use, particularly in rural areas. (Arch Surg1987;122:992-996)

Two cases of massive hemoperitoneum secondary to spontaneous rupture of hepatic metastases are presented. This devastating complication of hepatic malignant disease is difficult to diagnose preoperatively. However, the diagnosis should be considered in patients with known malignant disease who present with unexplained blood loss, shock, or signs consistent with an acute surgical abdomen. The presence of fever and leukocy-tosis with these signs and symptoms may also be part of the clinical picture. Treatment by hepatic resection is never curative. Review of the literature indicates that local control of the bleeding site by suture ligature, packing with topical hemostatic agents, or hepatic artery ligation offers the best chances of obtaining hemorrhage control and some degree of palliation in these desperately ill patients.

A retrospective review of 312 hospitalized patients with cervical spine injuries was conducted to identify presenting signs, symptoms, and coexisting conditions, and to determine if any injuries were not diagnosed in the emergency department. Of the 257 (82%) patients who were alert on ED evaluation, 215 (84%) complained of neck pain or tenderness. Of the remaining 42 alert patients without neck pain, 34 had sensory or motor symptoms or signs suggestive of cervical spine injury, and eight had significantly painful other injuries. Of the 284 patients presenting within the first 48 hours after injury, 23 were not diagnosed initially, 21 because radiographs were initially read as negative and two because no radiographs were taken. A significant number of patients had more than one fracture of the spinal column. A stepwise approach to rational ordering of cervical spine radiographs in blunt trauma is proposed.

A xeromammogram led to the surgical excision of a calcified breast lesion on a 66-year-old female. Before specimen mammography was performed, the excised tissue was oriented with tattoo pigment. The specimen mammogram then revealed multiple calcifications caused by unsuspected radio-opaque material in the tattoo pigment, and the original calcifications were obscured. This case demonstrates the hazards involved utilizing tattoo powders for orienting xeromammographically discovered specimens.