Of all operable cases of breast cancer, there was a 25070 mortality in five years. The maximum incidence of presentation occurred in the 46-50 and 61-65 age groups. The size of the tumour and the presence of axillary lymph nodes are factors which adversely affect the prognosis. The presence of a 'lymphocytic response' in the tumour appears to make no difference to prognosis in this group. Radical and simple mastectomy produce similar results, although in the group 'Radical Mastectomy without lymph node involvement' the results are best. The use of various combinations of intravenous and orally administered chemotherapy is discussed.
All patients with chronic renal failure have secondary hyperparathyroidism shown by elevated serum parathormone. Medical and surg ica l treatment is designed to minimise its effect. Medical treatment invol ves the use ofphosphate binders. one alpha and increased frequency of dialy sis. Surgery is indicated when medical treatment fails to control the ci+ poilevels that activate renal osteodystrophy. High alkaline phosphatase and Ca 2+ above 2.7 rnmol/l are indications for surgery. Careful preoperative preparation and postoperative control minimise complications of haemorrhage, sepsis, tetany and cardiac arrhythmias. Long-term complications are hypoparathyroidism and recurrent hyperparathyroidism. Shortened dialysis periods may lead to increased parathyroid complications. Fig l. Secondary hyperparthyroidism: calcification of the left shoulder.
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