Volume 92, Issue 8

Male breast cancer is difficult to study because it occurs infrequently, accounting for 1% of all breast carcinoma. Breast cancer occurs 10 years later in men than in women, and its presentation parallels that in women. The authors retrospectively review 13 cases of male breast cancer occurring over a 20-year period in four community hospitals. Treatment methods paralleled those used for female cancer patients. Surgery, primarily radical mastectomy, was performed in all patients. In the eight patients in whom hormone receptor assays were obtained, all tests were positive for estrogen receptors, progesterone receptors, or both. Metastases were diagnosed in five patients during follow-up. The longest disease-free survival has been 10 years. Similarities and differences regarding male and female breast cancer are discussed as are the diagnosis and management of men with this disease.

Two multicenter controlled clinical trial~ of genetically engineered monoclonal antibodies directed against endotoxin, a potent mediator of inflammation in the gram-negative sepsis syndrome, were recently reported in the medical literature. One of these antiendotoxin antibodies was derived from a murine (mouse) source, and the other antibody was derived mainly from a human source (nebacumab [negative bacteria human monoclonal antibody D. This article reviews recent literature concerning' the use of these agents in the treatment of gram-negative sepsis syndrome. It also projects economic assessment data regarding the use of nebacumab in the United States.

Antiphospholipid antibody syndromes are primarily manifested as unexplained thrombotic events. Several antiphospholipid antibodies have been identified, the lupus anticoagulant being the most recognized. Considerable confusion surrounds this "anticoagulant," which is highly correlated with an increased risk of thrombosis. Several assays have been designed for the detection of antiphospholipid antibodies. There are limitations on their efficacy and interpretation requires judgment. Treatment strategies for the clinical manifestations of the antiphospholipid antibody syndrome are being developed. The explosive rise in the volume of literature dedicated to this topic will assure new and improved modalities for evaluation and treatment.

Gastric acid suppression by use of either antacids or histamine H2-receptor antagonist therapy is the mainstay of stress ulcer prophylaxis. Available evidence indicating an antimicrobial role for gastric acid calls for the reevaluation of gastric acid suppression. A pH of greater than 4.0 leads to bacterial overgrowth and colonization of the upper gastrointestinal tract which has been associated with nosocomial pneumonia, bacterial translocation from the gut, systemic sepsis, and. multiple-organ failure. The availability of alternative therapy should discourage the routine use of acid-suppression therapy in the critically ill patient.

During a 25-year period, four types of hepatitis-causing virus have been identified and can now be evaluated serologically. This final article in this clinical laboratory medicine series reviews routes of virus transmission and persistence and the availability of tests.

This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an education grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.

As a form of verbal or nonverbal communication intended to promote learning, feedback plays an important role in the medical training process. More often than not, however, feedback is given-and received-inappropriately by both clinicians and residents, respectively. This article outlines common types of instructional feedback, their inherent advantages and disadvantages, and suggests ways in which clinicians and residents may incorporate feedback effectively in a residency/training program.

Fungal infections of the nose and paranasal sinuses are uncommon; Aspergillus is the most frequently isolated fungal pathogen. Invasive aspergillosis is commonly seen as an opportunistic infection in the immunocompromised, debilitated host. Whereas fulminant infection in the otherwise healthy patient is rare, in the immunocompetent host with persistent signs and symptoms of sinusitis despite appropriate medical management, aspergillosis should be considered. Treatment of paranasal sinus aspergillosis requires correction of immunologic deficits, if possible; aggressive surgical debridement to provide adequate drainage and aeration of the sinuses; and adjunctive antifungal chemotherapy. The authors present an unusual case of invasive aspergillosis of the paranasal sinuses in fin immunocompetent host.

The obstructing thrombus in a totally occluded internal carotid artery may act as a source of cerebral emboli. These emboli traverse the external carotid and ophthalmic arteries and enter the intracranial circulation via retrograde collateral pathways. Surgical treatment can result in complete abatement of symptoms in selected patients. The authors describe internal carotid "stump" syndrome in a 47year-old man and discuss the options for surgical management.

The authors report a case of eosinophilia-myalgia syndrome with a progressive neuromyopathy. Progressive weakness, myalgia, and dermatitis developed in the patient described after chronic ingestion of high-dose L-tryptophah for insomnia. Laboratory, electrophysiologic, and muscle biopsy results support the diagnosis of an inflammatory myopathy consistent with that of eosinophilia-myalgia syndrome. The patient's weakness led to wheelchair dependency. A review of the literature regarding this disorder shows inconsistent results with steroid and other modes of therapy. After a course of high-dose steroids with long-term tapering and vigorous inpatient and outpatient rehabilitation, the patient was able to walk and function independently within 2 months.