To explore whether Paget's disease (PD) has an effect on outcome in patients with breast cancer. Design: Retrospective analysis of comprehensive pathology database, medical records, and slides of samples showing pathologic features.

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The availability of transcutaneous monitors has provided a means of non invasive assessment of CO(2) tension and a trend of the ventilation status commonly in infants and neonates. The authors describe two cases of hypercapnia diagnosed early in adults by the non invasive transcutaneous measurement of carbon dioxide (tcpCO(2)) using TINA TCM4 in postoperative cardiac surgical patients who were mechanically ventilated. Curiously, this increase in tcpCO(2) levels was associated with a false increase in the tcpO(2) values though no changes in the ventilatory parameters to increase oxygenation were made. The probable mechanism of the increase in tcpO(2) levels with hypercarbia is discussed.

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Renal dysfunction is known to occur during cardiac surgery. A few factors such as perioperative hypotension, use of potential nephrotoxic therapeutic agents, radio opaque contrast media in the recent past, intra-aortic balloon pump (IABP) and cardiopulmonary bypass have been blamed as the contributing factors to the causation of postoperative renal dysfunction in cardiac surgical patients. At times, in patients with renal failure and low cardiac output status, one may face the dilemma if the use of IABP is safe. We undertook this prospective observational study to determine the degree of possible renal injury when IABP is used by measuring serial values of serum creatinine and Cystatin C. Elective patients scheduled for off-pump coronary artery bypass surgery requiring preoperative use of IABP were included in this study. Cystatin C and serum creatinine levels were checked at fixed intervals after institution of IABP. Twenty-two patients were eligible for enrolment to the study. There was no significant change in the values of serum creatinine; from the basal value of 1.10 ± 0.233 to 0.98 ± 0.363 mg /dL (P value >0.05). Cystatin C levels significantly decreased from the basal level of 0.98 ± 0.29 to 0.89 ± 0.23 (P value <0.05). Contrary to the belief, Cystatin C, the early indicator of renal dysfunction decreases suggesting absence of renal injury after the use of IABP. Absence of elevation of cystatin C levels in our study suggests the lack of potential of the IABP to cause renal dysfunction in patients who received elective IABP therapy preoperatively.

The accuracy of transcutaneously measured values of oxygen improved significantly during spontaneous ventilation.

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