Paroxetine hydrochloride is a promising new treatment for hot flashes in breast cancer survivors, and warrants further evaluation in a double-blind randomized placebo-controlled trial.

June 18 : Operation under ethyl chloride and ether (Dr. Goodhart). A left paramedian incision was made. Para-oesophageal herniation of the central portion of the greater curvature of the stomach was found. (Fig. 95.) Reduction was achieved after mobilization of the left lobe of the liver. The small hernial orifice was not closed Off.Convalescence was uninterrupted. The baby was discharged on July 5, weight 7 lb. 6 oz., and has remained well. COlMlMENTSI . I n both cases the greater curvature became the highest point in the hernia, causing a volvulus effect. This might have occurred through the greater curvature being pushed up by dilatation of the transverse colon, until the diaphragm hiatus was reached; the negative pressure in the thorax may then have sucked the stomach through the diaphragm.2. Both cases were successfully treated by operation through an abdominal approach.3. Strangulation of the stomach by volvulus in a diaphragmatic hernia is a rare condition, and it would appear that the obstructive symptoms were due to the rotation of the stomach on its long axis rather than to constriction by the diaphragm at the hiatus.

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Link to publication Citation for published version (APA): Jirström, K., Rydén, L., Anagnostaki, L., Nordenskjold, B., Stal, O., Thorstenson, S., ... Landberg, G. (2005). Pathology parameters and adjuvant tamoxifen response in a randomised premenopausal breast cancer trial. Journal of Clinical Pathology, 58(11), 1135-1142. DOI: 10.1136/jcp.2005 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background: Subgroups of breast cancer that have an impaired response to endocrine treatment, despite hormone receptor positivity, are still poorly defined. Breast cancer can be subdivided according to standard pathological parameters including histological type, grade, and assessment of proliferation. These parameters are the net result of combinations of genetic alterations effecting tumour behaviour and could potentially reflect subtypes that respond differently to endocrine treatment. Aims: To investigate the usefulness of these parameters as predictors of the response to tamoxifen in premenopausal women with breast cancer. Materials/methods: Clinically established pathological parameters were assessed and related to the tamoxifen response in 500 available tumour specimens from 564 premenopausal patients with breast cancer randomised to either two years of tamoxifen or no treatment with 14 years of follow up. Proliferation was further evaluated by immunohistochemical Ki-67 expression. Results: Oestrogen receptor positive ductal carcinomas responded as expected to tamoxifen, whereas the difference in recurrence free survival between control and tamoxifen treated patients was less apparent in the relatively few lobular carcinomas. For histological grade, there was no obvious difference in treatment response between the groups. The relation between proliferation and tamoxifen response seemed to be more complex, with a clear response in tumours with high and low proliferation, whereas tumours with intermediate proliferation defined by Ki-67 responded more poorly. Conclusions: Clinically established pathology parameters seem to mirror the endocrine treatment response and could potentially be valuable in future treatment decisions for patients with breast cancer.

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