Eccrine porocarcinoma is a malignant tumor of eccrine sweat glands. It is a very rare, slow growing tumor and clinically resembles other skin cancers. We report a case and review its clinical and pathological features. These tumors have a propensity for local recurrence, and wide excision with negative margins is recommended.

Primary laryngeal amyloidosis is a rare benign disease of unknown aetiology. It can present with dysphonia or stridor. A woman presenting with airway compromise, who required a tracheostomy, is reported. (Postgrad Med J 2000;76:364-365) Keywords: laryngeal disease; amyloidosis Case report A 47 year old woman presented with a seven year history of dysphonia which had deteriorated recently. Fibre optic laryngoscopy showed polyps on the right false vocal cord with a suggestion of subglottic stenosis (fig 1). The true vocal cords were mobile and appeared normal.While awaiting further investigation, she presented with airway compromise requiring urgent tracheostomy. Direct laryngoscopy revealed subglottic oedema. The polypoid lesion was biopsied and showed features suggestive of amyloidosis and this was confirmed after staining with Congo red. A flexible bronchoscopy through the tracheostomy tube showed isolated nodules within the trachea (fig 2). Full blood count and erythrocyte sedimentation rates were normal.At follow up a year later she was noted to have a change in voice. Fibre optic laryngoscopy showed new lesions on the right and left true vocal cords. These were resected with a carbon dioxide laser. The result was a subjective improvement in the quality of her voice and airway. She was decannulated two months later. She remains under review and requires no further intervention. DiscussionAmyloidosis is a benign, slowly progressive condition that is characterised by extracellular fibular proteins. Diagnosis is confirmed by histopathological specimens that stain with Congo red.1 Amyloidosis can be classified as either primary, developing spontaneously, or secondary to some other longstanding inflammatory disease such as rheumatoid arthritis. The primary form can be further subdivided into a localised form, where deposits are confined to a single organ or location, or generalised, where deposits are found to some extent in all tissues.The most common presenting symptoms of primary laryngeal amyloidosis are dysphonia and stridor. Rarely, airway compromise occurs and an alternative airway may be necessary. The presence of tender bones, lymphadenopathy, or splenomegaly should alert the clinician to the possibility of generalised amyloidosis. Learning points x Amyloidosis is a rare benign disease of unknown aetiology. x Laryngeal amyloidosis can present with hoarseness or stridor which may require tracheostomy. x Histological diagnosis from a biopsy specimen can be confirmed with characteristic staining with Congo red. x Treatment is by surgical resection using the carbon dioxide laser. Repeated resections may be necessary. Localisation of lesions in the larynx is to the ventricle, false vocal cords, true vocal cords, aryepiglottic folds, and subglottis in that order of frequency.2 4 Histology of the biopsied specimen using routine haematoxylin and eosin stain shows amyloid as eosinophilic extracellular infiltrate. Further staining with Congo red reveals characteristic apple green birefringence with a ...

We present two cases of a rare form of intraductal carcinoma of the breast, "cystic hypersecretory carcinoma of the breast." The clinical and pathologic characteristics of the lesion are discussed, along with a review of the literature.

SummaryBetween January and July 1995, 227 patients at the Bronx-Lebanon Hospital Center had positive fungal cultures. Candida spp were the most common fungi isolated. Forty-three patients with invasive disease, as indicated by fungus-positive blood cultures, became the focus of our study. C albicans caused fungaemia in 21 patients (49%). Twenty-eight patients (65%) were less than 50 years of age; three were neonates. The most common presenting symptoms were fever, chills, and weakness (20 patients, 47%). Thirty patients died, giving a mortality rate of 70%. The patients who died stayed in the hospital an average of 49 days.The highest mortality occurred among patients who became bacteraemic before or at the same time they became candidaemic (24 of 26 patients) or who were receiving broad-spectrum antibiotics (20 of 26 patients). We also found high mortality rates from invasive fungal infection among patients with HIV infection, a central venous catheter, and liver, renal, or respiratory failure. We did not find any increase in the incidence of invasive fungal infection or mortality among leukopenic or diabetic patients.

The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. All patients underwent perioperative ultrasound assessment of the venous access site, followed by fluoroscopic confirmation of the catheter placement. Data from medical charts and the hospital computer system were subjected to statistical analysis. A total of 126 patients underwent ultrasound-guided placement of a hemodialysis catheter in a central vein; 58 had undergone prior placement of a central vein catheter, but 69 had not. Patients in the later group had a 100 per cent success rate in catheter placement after ultrasound assessment of one central vein. Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded central veins. This protocol is effective and improves patient safety.

We present our first experiences with the use of a new minimally invasive treatment of lower extremity varicose veins. We studied the occlusion rates of the great saphenous vein (GSV) with laser ablation, its failure rates, and its complications. Sixty-six limbs in 62 consecutive patients were treated and followed-up for 1 year. All of the patients had incompetent GSV proven by means of duplex scanning. The GSV segment from 2 cm distal to the sapheno-femoral junction to just above the knee was ablated by using laser energy. In addition, all patients had stab avulsions of the varicose veins of the leg with Crochet hooks. All patients were followed post-operatively on the 3rd day, 1 month, 3 months, and 1 year after surgery. All patients were treated as day-case surgeries. Among 62 patients studied, 46 patients were women (74%) and 16 were men (26%). The median age of the patients was 53 years (range 28–69 years). Median operation time was 65 min (range 40–140 min). Successful treatment (total obliteration of the GSV on duplex) was accomplished in 64 of 66 limbs (97%). In two cases, recanalization of the lower one-third of the treated segment of the GSV was noted after 3 months. There were no instances of neuropathy or skin burn. Endovenous laser ablation of varicose veins is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. The procedure seems to be a promising alternative for surgical stripping of the GSV.

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SummaryWe present a case of an in-situ lobular carcinoma within an otherwise benign fibroadenoma in a 45-year-old woman.