Formalin fixed, paraffin embedded tissue from 100 consecutive cases of breast carcinoma were studied for binding with Helix pomatia (HPA) and Ulex Europeus (UEA1) lectins. Serial sections were pretreated with trypsin or neuraminidase to determine the effect of these enzymes on lectin binding. The lectins were visualized by the peroxidase antiperoxidase technique and the cell staining proportion assessed in a semi-quantitative manner under the light microscope. Correlating staining with prognostic factors and patient follow-up details showed that UEA1 related to disease-free interval and survival, and HPA to lymph node stage, time to loco regional recurrence and to survival. Relationships with both lectins were abolished by pretreatment with neuraminidase. The study demonstrates that a simple assessment of lectin binding can provide prognostic information in breast cancer. This may be useful particularly when conservational surgical practice restricts the amount of nodal tissue for staging.

In this study of lower third molar extraction, oral paracetamol is not inferior to i.v. for postoperative analgesia. ISRCTN Registration http://www.controlled-trials.com/ISRCTN77607163.

No abstract

Burns make a significant contribution to paediatric hospital admissions; in 1 year, around 50,000 such patients attended accident and emergency departments and of these approximately 6400 attend a burns unit. 1 Most burns occur at home, usually in the kitchen and bathroom. The aetiology changes with age; younger children suffer more scalds, older children more flame burns. Outwardly, burns treatment for children is similar to that for adults, but there are significant physical, psychological, and social differences. Paediatric surgical services are no longer an appendage to those for adults, and the burns team must be able to manage these different needs. A given injury inflicts a greater burn on a child. Children have thinner skin, lose proportionately more fluid, are more prone to hypothermia, and mount a greater systemic inflammatory response. Their youthfulness does make possible early, aggressive surgery and they demonstrate extraordinary ability to adapt to injury and survive extensive burns that are fatal to most adults. The focus of this article is the immediate and day-today management of children requiring admission to hospital for burns. The prolonged management of massive burns and inhalation injury is beyond the scope of this paper. Local pathophysiology Burns are usually caused by contact with a source of heat; in infants and children, temperatures as low as 408C can rapidly inflict a significant injury. At the area of contact, there is coagulation of tissues surrounded by capillary stasis, aggravating the extent of cell injury by hypoxaemia. The depth to which dermal elements are destroyed affects their ability to regenerate from deeper elements; destruction of all dermal cells, including sweat glands and hair follicles, results in permanent loss of skin. Classification Although not always easy to assess in the first few hours, the site, depth, and extent of burns are critical factors in management, healing, and outcome. Essentially, specialist services are required for full-thickness burns exceeding 5% of body surface area (BSA), partial thickness exceeding 10% inhalation burns or burns to the airway, face, hands, feet, and perineum. Any concern of non-accidental injury or lack of care at home for the child necessitates admission to hospital.