BACKGROUND:Bacillus species infection of the joints is a very rare occurrence, with sporadic reports in the medical literature.CASE REPORT:A 67-year-old woman with osteoarthritis developed infection in the knee joint after arthroscopy. Percutaneous needle aspiration of articular fluid performed post-operatively showed a positive culture for Bacillus species. The diagnosis of septic arthritis was, however, not confirmed as the results were considered contamination. Failure of treatment with beta-lactam antibiotics on two occasions and successful cure of infective arthritis by long-term administration of a fluoroquinolone confirmed iatrogenic clinical joint infection with Bacillus species.CONCLUSION:Any clinically suspected joint infection must be treated as septic arthritis until proved otherwise.

Brustkrebs: Lapatinib als First-Line-Kombination verzögert Erkrankungsprogression Die Zulassungserweiterung für Tyverb® stützt sich auf Ergebnisse der Studie EGF30008. Diese randomisierte Phase-III-Studie prüfte Lapatinib in Kombination mit dem Aromatase-Inhibitor Letrozol bei Frauen mit Hormonrezeptor-positivem metastasiertem Brustkrebs. Der ErbB2Rezeptor-Status war für die Aufnahme in die Studie nicht von Bedeutung. Die Patientinnen waren nicht mit Trastuzumab oder einem AromataseInhibitor vorbehandelt [1, 2]. Bei der Auswertung zeigte sich bei Patientinnen mit Hormonrezeptorund ErbB2-positivem Tumor für die Kombination Lapatinib plus Letrozol eine signifikante Verlängerung des progressionsfreien Überlebens im Vergleich zu Placebo plus Letrozol: 8,2 Monate im Vergleich zu 3 Monaten [1]. Unerwünschte Ereignisse unter der Kombinationstherapie Lapatinib plus Letrozol waren im Wesentlichen Durchfälle und Hautausschläge, meist vom Schweregrad 1 oder 2 nach WHOKlassifikation und gut behandelbar. Die empfohlene Dosierung für die Kombination beträgt 1500 mg (d.h. 6 Tabletten) einmal täglich fortlaufend; die Einnahme des Aromatasehemmers bleibt sowohl hinsichtlich der Dosierung als auch der Art der Anwendung unverändert.

If mastectomy is indicated for removal of breast cancer, the nipple areola complex (NAC) is routinely excised during surgery followed by nipple reconstruction. Despite advances in reconstruction techniques, removal of the NAC often results in a sense of mutilation. However, recent studies regarding the tumorigenic involvement of the NAC have provided some evidence that in carefully selected patients the NAC could be preserved. Nipplesparing mastectomy (NSM) preserves the breast skin envelope and the NAC, and has therefore emerged as an alternative to conventional radical mastectomies. BecauseNSM leaves no or sparse retroareolar ductal tissue, NSM is increasingly considered as oncologically safe both in patients with small and peripherally located tumors and in women with high breast cancer risk, who opt for prophylactic mastectomy. Moreover, NSM has been applied in patients with large and centrally located or multicentric invasive carcinomas but oncologic safety as well as postoperative complications such as NAC necrosis are still controversial. Since long-term data are limited, there is no general recommendation for NSM indications. To evaluate if indications for NSM may be rather enlarged under certain conditions, we performed a MEDLINE search for studies published between 2003 and 2009.