Search

Electrochemotherapy has been proven to be an efficient treatment for cutaneous metastases of various cancers. Data on breast cancer (BC) patients with cutaneous metastases were retrieved from the INSPECT database. Patients were divided by their receptor status: HER2+, HR+ (ER/PgR+), and TN (triple negative). Groups were similar for histological subtype and location of the nodules. Most patients were previously treated with surgery/systemic therapy/radiotherapy. We found no differences in the three groups in terms of response ratio (OR per patient 86% HER2+, 80% HR+, 76% TN, p = 0.8664). The only factor positively affecting the complete response rate in all groups was small tumor size (

Aim Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns, and decrease the need for surgical intervention. Several studies outside of Ireland demonstrate inadequate parental knowledge of burns first aid, but few evaluated interventions to improve knowledge. Consequently our aim was to assess parental/caregiver knowledge in Ireland, and determine if knowledge levels could be raised following a short educational video intervention. Methods An educational video based on current European and British best practice guidelines was produced and shown to parents/caregivers waiting in the Pediatric Outpatients Department after a previously validated pre-intervention questionnaire was completed. A post intervention questionnaire was completed following the video. Questionnaires assessed demographics, previous experience and included scenarios to test parental knowledge. Results 112 parents/caregivers (81.3% female (n = 91), 18.8% male (n = 21)) were questioned. Baseline knowledge was found to be poor overall, however this significantly improved with a simple educational video (pre-score 31.9%, post-test mean score knowledge 92.1%). Pre- and post-test scores showed a statistical significance (x2 = 71.117, P 0.05). Conclusion The study found poor parental knowledge of burns first aid in Ireland and shows the use of an educational video was effective in raising knowledge levels.

Background Cutaneous recurrence from breast cancer can pose a clinical challenge. It might be the only disease site, or could be part of disseminated disease, and often profoundly affects quality of life. Electrochemotherapy is a palliative treatment using electric pulses to locally permeabilize tumor cells and thereby significantly increase bleomycin cytotoxicity. Collaborating with the International Network for Sharing Practice on ElectroChemoTherapy (INSPECT), we consecutively and prospectively accrued data on patients treated with electrochemotherapy for cutaneous metastases from breast cancer. Patients and Methods Patients were treated with electrochemotherapy at 10 European centers. Under either local or general anaesthesia patients were treated with either local injection (1000 IU/mL intratumoral) or systemic infusion (15,000 IU/m2) of bleomycin. Results One hundred nineteen patients were included at 10 institutions in the INSPECT network. The primary location was the chest (89%), the median diameter of the cutaneous metastases was 25 mm. Ninety patients were available for response evaluation after 2 months. Complete response was observed in 45 patients (50%), partial response in 19 (21%), stable disease in 16 (18%), and progressive disease in 7 (8%). Three patients were not evaluable. Common side effects were ulceration, long-lasting hyperpigmentation, and low-grade pain. No serious adverse events were observed. Conclusion Electrochemotherapy showed high response rates after a single treatment. Electrochemotherapy has few side effects and can be used as an adjunct to systemic therapies or as a solo treatment. We therefore recommend considering electrochemotherapy for patients with cutaneous metastases.

A 4 1-year-old man presented with an occult median nerve injury. This report highlights the importance of adequate wound exploration and reinforces the significance of adequate history and examination in patients with signs of nerve injury.

A 65 year old male retired farmer presented with an inability to fully straighten the ring finger and little finger of his right hand. This had progressed over the past two years and he had recently noticed a “rope like” swelling in his palm. He had no history of trauma and no medical history of note, except that he had smoked until 10 years earlier and had a 90 pack year history. His father had a similar deformity. Examination showed palpable cords to his middle, ring, and little fingers. He had palpable nodules on the volar aspect of all proximal phalanges, which caused flexion contractures of the proximal interphalangeal joints. The cord and nodules in the ring finger were adherent to the overlying skin. The most severe flexion contractures were seen in the ring finger, with 25° and 36° contractures of the metacarpophalangeal joints and proximal interphalangeal joints, respectively (fig 1⇓). Fig 1 Contractures of the metacarpophalangeal and proximal interphalangeal joints of the ring finger and little finger of the right hand. The skin was affected on the volar aspect of the metacarpophalangeal joint of the ring finger (outlined in blue; A) ### 1. What is the most likely diagnosis? #### Short answer Dupuytren’s disease. #### Long answer The most likely diagnosis is Dupuytren’s disease.1 This is a fibroproliferative disease of the palmar fascia, which can lead to permanent flexion contractures of affected digits. Dupuytren’s disease mainly affects older men of northern European descent. Prevalence ranges from 0.6% to 31.6% in general populations in Western countries and increases with age.2 The disease has a strong genetic component, which had been attributed to an autosomal dominant gene of …

The practice of medicine can take all forms, and the diversity and adaptability that we sometimes require continue to amaze and intrigue me. In my short career I have had strange requests and patients, from seeing a Sioux child who had been shot by an arrow and delivering babies in hospital car parks to learning about and adapting to the world of molecular biology. None prepared me for a request that I received while …