Fear of cancer recurrence is common among breast cancer (BC) survivors. We investigated methods of diagnosing recurrence and their association with survival. Metastatic diagnoses were most commonly made by patient-reported symptoms, and there was no survival difference by diagnostic method, which, we hope, will ease the anxiety experienced by BC patients. Background: Breast cancer (BC) patients undergoing surveillance often fear recurrence. Given that routine imaging is not recommended, recognizing metastatic disease early requires a knowledge of recurrence patterns. The aim of this study was to analyze the most common presentations of metastatic disease. Patients and Methods: A retrospective review was conducted of patients who were initially diagnosed with early-stage BC and who later developed metastatic disease. Data collected included method of metastatic disease diagnosis, types of symptoms at diagnosis, and survival. Chisquare tests as well as logistic and Cox regression models were used. Results: Metastatic diagnoses were made from reported symptoms in 77.6% of patients, clinical examination in 3.2%, and 7.8% incidentally on imaging. Among those with symptoms, musculoskeletal pain was the most common (33.7%) and was more frequently noted at scheduled (48.9%) compared to acute-care visits (26.0%, P < .01). Receptor status was associated with nervous system symptoms at metastasis (P ¼ .01), with higher odds of nervous system symptoms in triple-negative (odds ratio ¼ 3.02) compared to estrogen receptor/progesterone receptorepositive, HER2cases. On multivariable analysis, initial stage (P ¼ .03), receptor status (P < .01), age (P < .01), and time to recurrence (P < .01) were significantly associated with 10-year survival after diagnosis of metastasis, whereas the presence of symptoms was not (P ¼ .27). Providers of BC patients undergoing surveillance should modify their threshold of suspicion for recurrence depending on the characteristics of the initial diagnosis and the symptoms subsequently reported. Conclusion: In this retrospective study, patients who presented with symptoms did not have shorter survival compared to those who were diagnosed in other ways.
Introduction:The liver is the organ most commonly affected by hydatid disease and is involved in up to 70% of cases. Surgical management can be open or laparoscopic; it can vary from a radical procedure such as hepatic resection or pericystectomy or a more conservative approach such as partial cystectomy. Bile leak after surgery can occur in between 13% and 26% of cases.
Case Description:We present the case of a 47-year-old patient who was diagnosed with 2 large hydatid liver cysts in segments V and VI and segments II and III, respectively. She underwent laparoscopic pericystectomy for both cysts and was discharged 2 days later. She presented after 10 days complaining of abdominal pain and fever. Computed tomography scan of the abdomen showed a 6 ϫ 7-cm collection at the surgical site of segments II and III. A percutaneous drain was inserted and drained 60 mL of dark bilious fluid. The patient did well after drainage and was discharged home after 6 days.Discussion: Irrespective of the surgical treatment chosen, bile leaks may complicate any procedure and must always be considered seriously. Although there have been numerous studies concerning bile leak after open surgery, there are only a few describing bile leaks after laparoscopic surgery. Managing bile leaks after hydatid cyst excision is still a matter of debate. Some physicians would advocate conservative management; other physicians would recommend a further procedure such as sphincterotomy or biliary stenting after endoscopic retrograde cholangiopancreatography.
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