Roper Hospital

Parker, Edward F. M.D.; Hanna, Charles B. M.D.; Postlethwait, Raymond W. M.D. Author Information

PURPOSE: Breathing pattern retraining is frequently used for exertional dyspnea relief in adults with moderate to severe chronic obstructive pulmonary disease. However, there is contradictory evidence to support its use. The study objective was to compare 2 programs of prolonging expiratory time (pursed-lips breathing and expiratory muscle training) on dyspnea and functional performance. METHODS: A randomized, controlled design was used for the pilot study. Subjects recruited from the outpatient pulmonary clinic of a university-affiliated Veteran Affairs healthcare center were randomized to: 1) pursed-lips breathing, 2) expiratory muscle training, or 3) control. Changes over time in dyspnea [modified Borg after 6-minute walk distance (6MWD) and Shortness of Breath Questionnaire] and functional performance (Human Activity Profile and physical function scale of Short Form 36-item Health Survey) were assessed with a multilevel modeling procedure. Weekly laboratory visits for training were accompanied by structured verbal, written, and audiovisual instruction. RESULTS: Forty subjects with chronic obstructive pulmonary disease [age = 65 +/- 9 (mean +/- standard deviation) years, forced expiratory volume 1 second/forced vital capacity % = 46 +/- 10, forced expiratory volume 1 second % predicted = 39 +/- 13, body mass index = 26 +/- 6 kg/m, inspiratory muscle strength = 69 +/- 22 cm H2O, and expiratory muscle strength (PEmax) = 102 +/- 29 cm H2O] were enrolled. No significant Group x Time difference was present for PEmax (P = .93). Significant reductions for the modified Borg scale after 6MWD (P = .05) and physical function (P = .02) from baseline to 12 weeks were only present for pursed-lips breathing. CONCLUSION: Pursed-lips breathing provided sustained improvement in exertional dyspnea and physical function.

OBJECTIVE: To review published and other available data comparing the effectiveness of liquid-based cytology preparations in detecting epithelial cell abnormalities in cervicovaginal (gynecologic) cytology as compared to the conventional Papanicolaou test. STUDY DESIGN: Available split-sample data comparing liquid-based gynecologic cytology preparations with the conventional cervical cytologic test were collated from published studies, unpublished studies reported on at professional meetings or in the press, and from Food and Drug Administration Premarket Clinical Trials on ThinPrep and AutoCyte PREP. Data were stratified with regard to use of newer preparatory instrument models, use of varying collection devices and different split-sample protocols. RESULTS: Available data from split-sample studies of liquid-based methods showed overall increased detection of epithelial cell abnormalities. Results have varied considerably from study to study and appear to be influenced by collection protocol methods and probably by collection devices' different delivery of cellular material in split-sample studies, first to the conventional smear and second to the liquid-based medium. Newer preparatory instrument models may also enhance detection. CONCLUSION: Liquid-based gynecologic cytology preparations increase detection of epithelial cell abnormalities, as compared to the conventional, single-slide cervical cytologic smear, based on available data from split-sample studies. The true potential impact of these methods in enhancing detection of epithelial cell abnormalities awaits accumulation of data from direct-to-vial studies, especially data on detection of biopsy-confirmed high grade squamous intraepithelial lesions from a wide variety-of clinical practice settings.

<h3>ABSTRACT</h3> This article examines recent changes in the two major components of nonresponse: inaccessibility of potential respondents and unwillingness of potential respondents to participate in an interview. It considers possible reasons for the increasing difficulty of establishing contact with potential respondents and also considers changes during the last few years in the number of potential respondents who generally refuse to participate in telephone surveys and the demographic correlates of these refusers. Finally, it discusses strategies for reducing the further erosion in response rates and implications of the findings as they bear on the future of telephone surveys.

Depamemtlaielt of Pathology, UniversitY of

BACKGROUND: Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES: To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS: The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS: The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS: The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.

Water-repellent (‘non-wetting’) soils are a major constraint to agricultural production in southern and south-west Australia, affecting &amp;gt;10 Mha of arable sandy soils. The major symptom is dry patches of surface soil, even after substantial rainfall, directly affecting agricultural production through uneven crop and pasture germination, and reduced nutrient availability. In addition, staggered weed germination impedes effective weed control, and delayed crop and pasture germination increases the risk of wind erosion. Water repellency is caused by waxy organic compounds derived from the breakdown of organic matter mostly of plant origin. It is more prevalent in soils with a sandy surface texture; their low particle surface area : volume ratio means that a smaller amount of waxy organic compounds can effectively cover a greater proportion of the particle surface area than in a fine-textured soil. Water repellency commonly occurs in sandy duplex soils (Sodosols and Chromosols) and deep sandy soils (Tenosols) but can also occur in Calcarosols, Kurosols and Podosols that have a sandy surface texture. Severity of water repellency has intensified in some areas with the adoption of no-till farming, which leads to the accumulation of soil organic matter (and hence waxy compounds) at the soil surface. Growers have also noticed worsening repellency after ‘dry’ or early sowing when break-of-season rains have been unreliable. Management strategies for water repellency fall into three categories: (i) amelioration, the properties of surface soils are changed; (ii) mitigation, water repellency is managed to allow crop and pasture production; (iii) avoidance, severely affected or poorly producing areas are removed from annual production and sown to perennial forage. Amelioration techniques include claying, deep cultivation with tools such as rotary spaders, or one-off soil inversion with mouldboard ploughs. These techniques can be expensive, but produce substantial, long-lasting benefits. However, they carry significant environmental risks if not adopted correctly. Mitigation strategies include furrow-seeding, application of wetting agents (surfactants), no-till with stubble retention, on-row seeding, and stimulating natural microbial degradation of waxy compounds. These are much cheaper than amelioration strategies, but have smaller and sometimes inconsistent impacts on crop production. For any given farm, economic analysis suggests that small patches of water repellency might best be ameliorated, but large areas should be treated initially with mitigation strategies. Further research is required to determine the long-term impacts of cultivation treatments, seeding systems and chemical and biological amendments on the expression and management of water repellency in an agricultural context.

Journal Article THE POLLS—A REVIEW: PREELECTION SURVEY METHODOLOGY: DETAILS FROM EIGHT POLLING ORGANIZATIONS, 1988 AND 1992 Get access STEPHEN VOSS, STEPHEN VOSS D. STEPHEN VOSS is a doctoral candidate in the Department of Government of Harvard University. ANDREW GELMAN is assistant professor in the Department of Statistics in the University of California, Berkeley. GARY KING is professor in the Department of Government of Harvard University. They thank the following individuals for their openness and detailed assistance: David K. Krane and Robert Spanski of Louis Harris and Associates; Martin Frankel, a consultant for Louis Harris and statistian at Baruch College; Kathleen Frankovic, Bala Ramnath, and Maria Kaye of CBS; Sharon Warden of the Washington Post; Kristen Conrad of Chilton Research; Dale Kulp and Amy Starer of Marketing Systems Group, responsible for the GENESYS Sampling System; Steve Shaw of Media General; Kathy Walenczyk and Linda Piekarski of Survey Sampling, Inc.; Dan Soulas of ICR Survey Research Group; Burns W. Roper, Peter Case, and Brad Fay of the Roper Organization; Hal Quinley of Yankelovich; Jeff Alderman of ABC; Shari Weber of Gallup; and especially Gallup's Jack Ludwig, who weathered the inherent inefficiency of a trial run. They also thank Mark Lew and Cassie Hartzog for programming assistance; Bradley Palmquist, Dale Kulp, Roger Purves, Bob Groves, and anonymous reviewers for comments and corrections; and the National Science Foundation for grants SBR-9223637 (to Gelman and King), DMS-9457824 (to Gelman), and SBR-932121 (to King). Gary King also thanks the John Simon Guggenheim Memorial Foundation for a fellowship during which time this research was completed. E-mail addresses are Voss, dsvoss@isr.harvard.edu; Gelman, gehnan@stat.berkeley.edu; King, gking@harvard. edu. Search for other works by this author on: Oxford Academic Google Scholar ANDREW GELMAN, ANDREW GELMAN D. STEPHEN VOSS is a doctoral candidate in the Department of Government of Harvard University. ANDREW GELMAN is assistant professor in the Department of Statistics in the University of California, Berkeley. GARY KING is professor in the Department of Government of Harvard University. They thank the following individuals for their openness and detailed assistance: David K. Krane and Robert Spanski of Louis Harris and Associates; Martin Frankel, a consultant for Louis Harris and statistian at Baruch College; Kathleen Frankovic, Bala Ramnath, and Maria Kaye of CBS; Sharon Warden of the Washington Post; Kristen Conrad of Chilton Research; Dale Kulp and Amy Starer of Marketing Systems Group, responsible for the GENESYS Sampling System; Steve Shaw of Media General; Kathy Walenczyk and Linda Piekarski of Survey Sampling, Inc.; Dan Soulas of ICR Survey Research Group; Burns W. Roper, Peter Case, and Brad Fay of the Roper Organization; Hal Quinley of Yankelovich; Jeff Alderman of ABC; Shari Weber of Gallup; and especially Gallup's Jack Ludwig, who weathered the inherent inefficiency of a trial run. They also thank Mark Lew and Cassie Hartzog for programming assistance; Bradley Palmquist, Dale Kulp, Roger Purves, Bob Groves, and anonymous reviewers for comments and corrections; and the National Science Foundation for grants SBR-9223637 (to Gelman and King), DMS-9457824 (to Gelman), and SBR-932121 (to King). Gary King also thanks the John Simon Guggenheim Memorial Foundation for a fellowship during which time this research was completed. E-mail addresses are Voss, dsvoss@isr.harvard.edu; Gelman, gehnan@stat.berkeley.edu; King, gking@harvard. edu. Search for other works by this author on: Oxford Academic Google Scholar GARY KING GARY KING D. STEPHEN VOSS is a doctoral candidate in the Department of Government of Harvard University. ANDREW GELMAN is assistant professor in the Department of Statistics in the University of California, Berkeley. GARY KING is professor in the Department of Government of Harvard University. They thank the following individuals for their openness and detailed assistance: David K. Krane and Robert Spanski of Louis Harris and Associates; Martin Frankel, a consultant for Louis Harris and statistian at Baruch College; Kathleen Frankovic, Bala Ramnath, and Maria Kaye of CBS; Sharon Warden of the Washington Post; Kristen Conrad of Chilton Research; Dale Kulp and Amy Starer of Marketing Systems Group, responsible for the GENESYS Sampling System; Steve Shaw of Media General; Kathy Walenczyk and Linda Piekarski of Survey Sampling, Inc.; Dan Soulas of ICR Survey Research Group; Burns W. Roper, Peter Case, and Brad Fay of the Roper Organization; Hal Quinley of Yankelovich; Jeff Alderman of ABC; Shari Weber of Gallup; and especially Gallup's Jack Ludwig, who weathered the inherent inefficiency of a trial run. They also thank Mark Lew and Cassie Hartzog for programming assistance; Bradley Palmquist, Dale Kulp, Roger Purves, Bob Groves, and anonymous reviewers for comments and corrections; and the National Science Foundation for grants SBR-9223637 (to Gelman and King), DMS-9457824 (to Gelman), and SBR-932121 (to King). Gary King also thanks the John Simon Guggenheim Memorial Foundation for a fellowship during which time this research was completed. E-mail addresses are Voss, dsvoss@isr.harvard.edu; Gelman, gehnan@stat.berkeley.edu; King, gking@harvard. edu. Search for other works by this author on: Oxford Academic Google Scholar Public Opinion Quarterly, Volume 59, Issue 1, SPRING 1995, Pages 98–132, https://doi.org/10.1086/269461 Published: 01 January 1995

A comparison is made between the results of standard intracarotid speech amytal testing and a new methodology, echoplanar blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI), in patients undergoing presurgical evaluation for intractable epilepsy. Of the 15 patients entered in the study, all had fMRIs while performing a verbal fluency task. Twelve of these patients also underwent standard intracarotid sodium amytal testing for speech and memory. Results of the fMRIs as compared to the intracarotid speech amytal testing are discussed, including agreement and disagreement between studies. Potential reasons for poor concordance are discussed, including complexity of the verbal fluency task, and motion and technical issues in MRI scan acquisition and data analysis.

Three hundred seventeen carotid endarterectomies performed on 240 consecutive patients in four Charleston hospitals were reviewed. The overall incidence of stroke was 10.7% and the mortality 3.2%. From these 317 operations a standardized series of 253 operations performed on neurologically stable patients was analyzed for neurologic complications as related to the use of an intra-operative shunt. Additional factors studied were length of time of carotid occlusion and degree of contralateral carotid stenosis. From the standardized series the incidence of stroke in 137 shunted cases was 9.5%, and in 116 non-shunted cases was 0.9%, a significant difference (p less than 0.01). Carotid artery occlusion times from 30 seconds to 12 minutes in the shunted group, and three minutes to 24 minutes in the non-shunted group had no relationship to the incidence of stroke. Significant contralateral carotid artery stenosis, present in 28/137 shunted cases and 30/116 non-shunted cases, had no predictive value in the development of a stroke. The use of an intra-operative shunt did not protect against stroke in these patients.

FROM THE DEPARTMENTS OF SURGERY, PATHOLOGY, AND MEDICINE, THE MEDICAL COLLEGE OF SOUTH CAROLINA AND THE ROPER HOSPITAL, CHARLESTON, SOUTH CAROLINA

Serum prolactin (HPR) levels are influenced by waking and sleep states, as reflected by surges in serum concentrations during daytime naps and nocturnal sleep. Other physiological causes of hyperprolactinemia include sexual activity, pregnancy, and lactation. Drugs may stimulate or inhibit HPR secretion. Pathological causes for HPR secretion include destructive lesions of the hypothalamus, prolactin-secreting neoplasms of the pituitary gland, lesions of the spinal cord, and occasionally Parkinson's disease. The most predictable postictal changes are increased serum cortisol levels and hyperprolactinemia. Serum HPR rises after virtually all generalized tonic-clonic seizures, most complex partial seizures, and some simple partial seizures. Absence and myoclonic seizures do not affect serum HPR levels. Repeated epileptic seizures and electroconvulsive therapy treatments produce successively less marked rises in serum HPR. The postictal elevation of serum cortisol has a longer latency than for HPR and follows an earlier rise in serum ACTH. Other postictal hormonal changes are much more variable. Because of the normal diurnal variation in serum cortisol levels and the relative delay in the postictal elevation of serum cortisol, HPR is more useful as a diagnostic measure of epileptic seizures. This application of HPR requires an understanding of other factors that influence serum HPR and the use of baseline serum HPR levels for comparison. HPR data must be correlated with behavioral and electroencephalographic events.

A 32-year-old African American woman with human immunodeficiency virus 1 (HIV-1) and a 3-year history of extensive facial molluscum contagiosum (MCV) presented to the dermatology clinic for treatment. The patient had been treated with multiple therapies, including liquid nitrogen, topical 0.05% liquid tretinoin, and 0.5% topical podofilox, with no improvement and some secondary irritation to the latter 2 therapies. At her initial appointment, she was taking nelfinavir mesylate (Viracept), 750 mg 3 times daily; stavudine (Zerit), 40 mg twice daily; didanosine (Videx), 200 mg twice daily; trimethoprim-sulfamethoxazole (Bactrim DS), 800 mg/160 mg every day; and fluconazole (Diflucan), 100 mg every day. She had been receiving nelfinavir, stavudine, and didanosine for 5 months and trimethoprimsulfamethoxazole and fluconazole since shortly after her diagnosis 3 years earlier. Her CD4 T-cell count was 0.004 3 10/L (38/mm) and the viral load (Roche Amplicor HIV-1 RNA–polymerase chain reaction [RNAPCR]) was at 2900 RNA copies/mL. This represented an approximately 1.5 log reduction in her initial viral load and had remained relatively stable during the past few months. On examination, there were papules and large nodules and plaques predominantly on the face. They ranged in size from 3 to 20 mm, with areas of depressed scarring and postinflammatory hyperpigmentation (Figure 1).

A 7-year tillage experiment was conducted on a deep sand in the central wheat belt of Western Australia between 1998 and 2004 to evaluate the impact of tillage intensity [no-tillage (NT), conservation tillage (CT), and rotary tillage (RT)] on soil organic matter, microbial biomass and function, and crop yields in a wheat–lupin rotation. A fourth treatment (subterranean clover pasture, Pasture) with least soil disturbance was included as a comparison. By March 2004, total soil carbon (C) in NT and CT increased by 4.4 and 2.6 t/ha, respectively, to an average of 17.6 t/ha in the top 0.1 m of the soil profile. There was a loss of total soil C in RT (–0.5 t/ha), which was significant compared with the other 2 tillage treatments. Total soil C and nitrogen (N) contents in the pasture treatment were similar to those in NT and CT at the end of the experiment. Labile fractions of soil C responded more rapidly to tillage practice, with significant reductions by 2001 in light fraction C and dissolved organic C in the RT treatment compared with the other 3 treatments. The effect of RT on biology and function was seen early in the experiment and, compared with Pasture, NT, and CT, intense tillage in RT significantly reduced microbial biomass and cellulase activity in the surface 0.05 m by the third year of the experiment. However, at a depth of 0.05–0.10 m there were no significant differences between treatments. Grain yields in NT, CT, and RT were unaffected by tillage except in 2003, when lupin yield under RT (1.6 t/ha) was significantly less than under NT (2.0 t/ha) and CT (1.9 t/ha). Minimal differences between NT and CT are a reflection of the minimum disturbance in the CT treatment, although there were significant differences between CT and NT in microbial indices such as microbial quotient and metabolic quotient, suggesting a future divergence of these treatments.

A case of multicentric secretory breast carcinoma in a 39-year-old white female is described. Mammograms, DNA analysis, touch preparation cytology, and positive estrogen receptors are reported for the first time in this rare favorable mammary carcinoma. A review of the 33 reported cases with follow-up in adult females, including the present case, has revealed lymph node metastases in nine (27%), recurrence in four (12%), and distant metastases leading to death in two cases (6%). In patients treated with less than simple mastectomy there has been local recurrence in 4 (33%) of 12 cases and in three of the four cases (75%) greater than or equal to 2.0 cm. Increased size and lack of gross circumscription of the neoplasm and presentation in the adult age group appear to identify cases with an increased risk of disease progression. In patients over 20 years old, especially with neoplasms greater than 2 cm in diameter, modified radical mastectomy has to date achieved the most favorable outcome. Minimal experience (two cases) is available regarding treatment with limited surgery and radiation therapy, and there is no available data regarding possible benefit from adjuvant chemotherapy.

PURPOSE: The purpose of this study was to examine the epidemiology of medical device-related pressure injuries (MDRPIs) in 3 long-term acute care hospitals (LTACHs). DESIGN: Retrospective descriptive study. SUBJECTS AND SETTING: The sample comprised 304 adult inpatients at 3 geographically diverse LTACHs: Spaulding Hospital for Continued Medical Care, Drake Center, and Bethesda Hospital. The facilities are located in the Northeastern, Southeastern, and Midwestern United States. METHODS: Hospital-acquired pressure injury (HAPI) data and MDRPI data were collected and reported for the 3 LTACHs from July 1, 2009, to June 30, 2010. Data were collected by the wound nurses at 2 of the facilities on a daily or weekly basis and quarterly at the remaining site. RESULTS: One hundred forty-two MDRPIs occurred during data collection, representing an occurrence rate of (47%). The proportion of MDRPIs and HAPIs at each of the LTACHs was 38%, 50%, and 47%, respectively. The most commonly reported medical devices causing pressure injury were respiratory devices, splints and braces, and tubing. CONCLUSIONS: The MDRPI rate identified in the LTACH setting was higher than rates reported in the literature. This study's findings confirm the importance of monitoring MDRPIs in order to implement appropriate prevention strategies.

Individual microbes often have defined relationships with their hosts that include beneficial, commensal, and pathogenic interactions. However, at the community level, plant microbiomes are considered to play a beneficial role in protecting the plant from potential pathogens, acquiring nutrients, and improving growth and production. Citrus is a globally important perennial fruit crop and its production faces many challenges. There has been tremendous interest in exploring the structure and function of the citrus microbiome and engineering the citrus microbiome to address various challenges. In this review, we summarized recent advances in understanding the citrus microbiome, including the composition and function of the microbiome in the rhizosphere, rhizoplane, endorhiza, and core members, and their functional traits. We conducted comparisons of the citrus root-associated microbiome with other plant root-associated microbiomes. We also present a perspective on how incoming pathogens interact with the resident microbial community and their outcomes. Despite the promising potential of the citrus microbiome to combat disease, harnessing the citrus microbiome for beneficial applications remains in its infancy. We envision that rapid development of high-throughput sequencing and multiomics technologies, artificial intelligence, consortia of microbes, genome editing technology, and high-throughput culturing present many exciting opportunities for citrus microbiome research and microbial engineering to improve citrus health and productivity.

Between 1966 and 1975, 425 patients with thoracic outlet symptoms were studied: 146 operative procedures were carried out in 103 of these patients. Division of soft tissues, only, in 129 cases offered relief of symptoms. In 10 cases bone resections (four cervical ribs, one second rib, one clavicle, and four first ribs) were done in an attempt to relieve the outlet problems. Preoperative evaluation included neurological consultation, x-rays of the neck and chest, detailed non-invasive oscillographic recordings of arterial flow during various outlet maneuvers, angiograms and in many instances electromyograms and nerve conduction studies. The axillary surgical approach to be various compression areas was preferred in that hyperabduction of the arm and costoclavicular maneuvers could be carried out under direct observation of the involved vessels. Accurate appraisal of the compression point could be assessed before and after the involved structure was divided or removed. Complications were limited to two hematomas postoperatively, and transient paralysis of the diaphragm in one patient. In all patients the vessel compression was relieved at the time of operation. In no instance was the first rib emperically removed as a "cure all" procedure. Six months following operation, patients were reevaluated and all except 8 patients (11 operative procedures) had relief of symptoms for a success rate of 92.5%.

We report long-term experience with the Charleston Bending Brace for treatment of adolescent idiopathic scoliosis. This brace holds the patient in maximal side-bending correction and is worn at nighttime only. Patients included in this prospective multicenter study met all of the following criteria: skeletal immaturity (Risser 0, 1, or 2), curvature >25° before bracing, no prior treatment, and >1-year follow-up since completion of bracing (skeletal maturity or progression to surgery). All curves were monitored and reported. There were 149 structural curves in 98 patients. Sixty-five (66%) patients showed improvement or <5° change in curvature. Seventeen (17%) patients progressed to the point of requiring surgery for their scoliosis. Based on these long-term results and improvement of the natural history of adolescent idiopathic scoliosis, continued use of the Charleston Bending Brace is justified.

The authors report a rare case of cutaneous angiosarcoma arising more than 5 years after excision of a 1.5 cm invasive ductal cancer of the breast. All lymph nodes were negative for metastatic breast cancer in this 68-year-old female. The patient had postoperative therapy consisting of 5040 cGy over a 5 week period using a 6 Megavolt linear accelerator. After radiation therapy to the breast and axillae, the patient developed chronic hard, taut edema of the irradiated right breast. Tamoxifen was administered for 5 years and then stopped. Three months after the cessation of tamoxifen, cutaneous angiosarcoma was found by skin biopsy. A complete mastectomy removed all tumor with clear margins. There are less than 60 cases of radiation associated breast angiosarcoma found in the literature. The presence of chronic lymphedema in the breast after radiation therapy possibly contributes to the development and is an early warning sign for later development of secondary angiosarcoma. The characteristic purple nodules and discoloration of the irradiated skin is the hallmark to suspect the diagnosis. The authors recommend long-term clinical surveillance for this tumor for all patients who have received breast conservative surgical therapy with concomitant radiation therapy for primary breast cancer.