Trastuzumab in metastatic breast cancer

Metastatic breast cancer is an incurable disease in a very high percentage of patients. Despite new progress in endocrine and other systemic therapies, this evidence remains challenging for patients and clinicians. HER2 protein is a member of the epidermal growth factor family of transmembrane receptors. HER2 is overexpressed in approximately 20% to 30% of breast cancers. Overexpression of HER2 has been shown to be associated with increased tumor proliferation and relative resistance to some types of chemotherapy and hormonal therapies. Trastuzumab, a humanized monoclonal antibody directed against HER2 protein, has been shown to be an efficacious and well tolerated treatment for HER2-overexpressing metastatic breast cancer, both as a single agent and when it is used in combination with chemotherapy.

Nutritional survey of patients in a general surgical ward: is there an effective predictor of malnutrition?

A survey of patients in a general surgical ward was undertaken to establish biochemical and anthropometric standards which could be used to detect malnourished patients in hospital. Results of biochemical and anthropometric tests of nutritional status were compared with assessment by a clinician and the quick nutritional index of Seltzer. Triceps skinfold thickness and serum albumin concentrations indicated that 29% and 35% of patients, respectively, were undernourished compared with 16% by clinical assessment and 17% by the quick nutritional index. Significant correlations (p less than 0.001) between serum albumin and transferrin concentrations and arm muscle area were found for men but not for women. Poor nutritional specificity and sensitivity of some anthropometric and biochemical tests may account for the difference in the level of undernutrition found by these tests and clinical assessment. This shows the importance of the choice of test in influencing the level of undernutrition detected.

Carcinoma of the head of the pancreas: bypass surgery in unresectable disease

One hundred patients who underwent bypass surgery for unresectable, histologically proven carcinoma of the head of the pancreas were studied to determine: the incidence of a second operation for duodenal obstruction in survivors who had a biliary diversion only; whether the addition of a prophylactic gastroenterostomy is associated with increased mortality. Eighty-six patients (Group A) had a biliary diversion alone while fourteen (Group B) had a biliary diversion and a prophylactic gastroenterostomy. Both groups were comparable regarding sex, age, symptomatology and clinical findings. The postoperative mortality was similar for both groups (Group A, 27.9 per cent; Group B, 14.3 per cent). The mean surgically related hospital stay was 22 +/- 6.5 days (Group A) and 20 +/- 7 days (Group B). Of the 62 patients in Group A who left hospital, 8 (13 per cent) required a second operation for duodenal obstruction (mean interval 5.4 +/- 2.7 months). The in-hospital stay for the second operation was 14.4 +/- 7.7 days. The overall survival for both groups was identical at 6 months (35.5 versus 33.3 per cent) and 12 months (19.3 versus 16.7 per cent). This study suggests that prophylactic gastroenterostomy adds no risk to patients requiring biliary diversion for carcinoma of the head of the pancreas. Its routine use is therefore justified since 13 per cent of the patients who survived the biliary diversion required further surgery for duodenal obstruction before death.

A patient with six primary carcinomata

We report a patient who developed six different primary carcinomata over a period of 3 years. These were of sigmoid colon, left breast, left kidney, right breast and two basal cell carcinomata of her face. These were all excised and she remains well with no apparent metastases 5 years after her initial presentation. Although patients with multiple tumours are uncommon, recognition of such an occurrence is important to avoid attributing symptoms to metastases from a previously diagnosed tumour. Sequential primary tumours may be amenable to treatment.