Psychologic testing was performed in 22 patients with advanced cancer (breast, endometrium, testis, lymphoma) who had undergone a complete remission that had been maintained for 5 to 20 years since the last therapy. The reaction to the probability of being cured was measured. The patients' overall attitude was very positive towards life and the future. They had a greater appreciation of time, life, people, and interpersonal reactions. They were less concerned about the nonessentials of life. It appeared that recovery from advanced cancer was a good experience for character development.
Cyanide gas forms during the combustion of synthetic polymers and should be considered in patients presenting with inhalation injuries. A persistently high lactate following adequate resuscitation may be an indicator of cyanide exposure. As cyanide poisoning can be rapidly fatal, prompt recognition and treatment of this condition is vital.
surgical excision. The literature is equivocal as to which holds actual superiority (Abe et al., 2004;Jebson and Spencer, 2007). Our findings regarding recurrence incidence are most closely matched to those of Turan et al. (2013), who showed an 89% incidence of success with the first puncture. We had a recurrence in two of 18 patients (11%). However, no recurrence was reported after a second puncture in our cohort. Our follow-up period ranged from 7 months to 8 years (with a mean of 36 months).Percutaneous puncture offers many advantages. It can be offered as immediate treatment at the time of clinical consultation, with no theatre time required. The consumables used for our technique are minimal, and a percutaneous puncture has the additional benefit of no downtime for the patient. Our study did not demonstrate any complications in patients managed with percutaneous puncture. Surgical excision comes at a higher cost when compared with percutaneous puncture. Postoperative incapacitation and recovery are additional factors along with potential complications, which include finger stiffness, scar tenderness, cold sensitivity and neurovascular injury (Finsen et al., 2013). A larger patient sample and a longer follow-up period may have also strengthened the validity of the study. Our series showed that using percutaneous puncture in the management of FTSG is a practical option in the light of the effort, cost and incidence of recurrence.Acknowledgements Dr Shameem Jaumdally for his assistance with the statistical analysis and layout.
A 78-year-old lady with a history of malignant melanoma on the dorsal aspect of her left foot, presented with a new fluorodeoxyglucose positron emission tomography (FDG-PET) avid lesion in her left fibular head.
The patient had been diagnosed eight months previously with a 5.1mm Breslow thickness invasive melanoma. Following initial diagnosis, she underwent a wide local excision and sentinel lymph node biopsy (SLN). The melanoma was completely excised and SLN was negative for malignancy.
Postoperatively, she underwent radiological staging with computed tomography scans (CT) of her thorax, abdomen, and pelvis. This showed scattered pulmonary nodules, and multiple indeterminate liver lesions. A PET scan was then performed, which showed an expansile, FDG-avid, lytic lesion in the left fibular head, suspicious for bone metastasis. Following discussion at the multidisciplinary team meeting, the patient underwent an open biopsy of the fibular head. Histology revealed non-necrotising epitheloid granulomata without evidence of malignancy. Ziehl-Neelsen and periodic acid Schiff stains were negative. The findings were suggestive of sarcoidosis.
The patient revealed she had a previous diagnosis of pulmonary sarcoidosis 25 years prior, however, had no known extrapulmonary disease and was not attending a specialist. The pulmonary findings on CT were consistent with sarcoidosis.
Sarcoidosis is a systemic inflammatory disease characterised by the development of non-caseating granulomata which typically affect the lungs and lymph nodes but can affect multiple organ systems. This case highlights the diagnostic uncertainty of an FDG-avid lesion on PET, necessitating diagnostic biopsy. Sarcoidosis is an uncommon but possible differential in this setting.
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