Strategies for morbidity control of axillary dissection for breast cancer

Breast cancer accounts for one third of all cancers in females in the Netherlands I and the incidence has been increasing world-wide in the past decades 2.. For the majority of patients, surgery forms the primary treatment of choice 3. Dissection of the axillary lymph nodes has been part of the surgical treatment since the introduction of radical mastectomy at the end of the nineteenth century 4 and has remained an important element in the management of breast cancer up until the present day 5. iniiiaily, lymph node dissection was considered to be essential for the cure of breast cancer, but over the last decades it has been primarily regarded as a staging procedure, with the secondary purpose of maintaining local control in the axilla 6,7, In the absence of reliable, non-invasive techniques, axillary lymph node dissection remains the most important method for determining axillary node status, A number of studies have reported the adverse effects of axillary lymph node dissection, which include seroma formation 8, edema of the arm and breast ,),10, shoulder dysfunction 11,12 and loss of sensation in the distribution area of the intercostobrachial nerves 11,13, The length of hospital stay after axillary lymphadenectomy for breast cancer is usually determined by the need for wound and drain management of the patient 14-16, Recently. clinicians have begun to explore the possibilities of earlier discharge of the patient, and the conclusion has been made that this offers saf

The composition of serous fluid after axillary dissection

Objective: To analyse the composition of the serous fluid formed after axillary dissection Design: Descriptive study Setting: University hospital and teaching hospital, The Netherlands Subjects: 16 patients whose axillas were dissected as part of a modified radical mastectomy for stage I or II breast cancer. Main outcome measures: Chemical and cellular composition of axillary drainage fluid on the first, fifth, and tenth postoperative days compared with the same constituents in blood and with reported data on the composition of peripheral lymph. Results and conclusion: On the first postoperative day the drainage fluid contained blood contents and a high concentration of creatine phosphokinase (CPK). After day one it changed to a peripheral lymph-like fluid but containing different cells, more protein, and no fibrinogen, making coagulation impossible. The reduction in the fluid production must be caused by other wound healing processes, such as formation of scars and connective tissue

The abuse of high dose estrogen/progestin combination drugs in delay of menstruation: The assumptions and practices of doctors, midwives and pharmacists in a peruvian city

The results are presented of a field study of the use of high dose Estrogen/Progestin combination drugs in Cusco, Peru, 1987. In Western countries the sale of these products is restricted. In the 1970s the use of high dose Estrogen/Progestin combination drugs as a hormonal pregnancy test was assumed to cause birth defects. Still these drugs have high sales data in Third World countries, where they are marketed for the treatment of menstrual disorders and for pregnancy diagnosis. A widespread misuse as abortifacient is assumed, although the abortive effect has never been proved. In this study 112 gynaecological consultations by doctors and 53 by midwives were observed. Seventeen health professionals and 26 salesmen in pharmacies were interviewed. It turned out that doctors and midwives prescribe high dose Estrogen/Progestin combination drugs to women whose periods are delayed. Of the consults 33% concerned this complaint. Women prefer "hindsight" birth control methods. Abortion is illegal. Under the cover of menstruation regulation or pregnancy diagnosis health professionals meet the wishes of women who search for an abortifacient. The products can easily be obtained without prescription. It is suggested that high dose Estrogen/Progestin combination drugs should be withdrawn from the market.pharmaceuticals high dose Estrogen/Progestin combination drugs Peru doctors midwives salesman in pharmacies hormonal pregnancy test abortifacients

Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial

Objective: To assess the medical and psychosocial effects of early hospital discharge after surgery for breast cancer on complication rate, patient satisfaction, and psychosocial outcomes. Design: Randomised trial comparing discharge from hospital 4 days after surgery (with drain in situ) with discharge after drain removal (mean 9 days in hospital). Psychosocial measurements performed before surgery and 1 and 4 months after. Setting: General hospital and cancer clinic in Rotterdam with a socioeconomically diverse population. Subjects: 125 women with operable breast cancer. Main outcome measures: Incidence of complications after surgery for breast cancer, patient satisfaction with treatment, and psychosocial effects of short stay or long stay in hospital. Results: Patient satisfaction with the short stay in hospital was high; only 4% (2/56 at 1 month after surgery and 2/52 at 4 months after surgery) of patients indicated that they would have preferred a longer stay. There were no significant differences in duration of drainage from the axilla between the short stay and long stay groups (median 8 v 9 days respectively, P=0.45) or the incidence of wound complications (10 patients v 9 patients). The median number of seroma aspirations per patient was higher for the long stay group (1 v 3.5, P=0.04). Leakage along the drain occurred more frequently in short stay patients (21 v 10 patients, P=0.04). The two groups did not differ in scores for psychosocial problems (uncertainty, anxiety, loneliness, disturbed sleep, loss of control, threat to self esteem), physical or psychological complaints, or in the coping strategies used. Before surgery, short stay patients scored higher on scales of depression (P=0.03) and after surgery they were more likely to discuss their disease with their families (at 1 month P=0.004, at 4 months P=0.04). Conclusions: Early discharge from hospital after surgery for breast cancer is safe and is well received by patients. Early discharge seems to enhance the opportunity for social support within the family