RESUMEN
Synchronous bilateral male breast cancer (MBC) is rare and only a few cases have been reported in the literature. The majority of MBC patients have no definable risk factors. We describe a case with Klinefelter's syndrome, prior thymic irradiation, testicular surgery, and first degree family history in a 61-year-old male.
RESUMEN
BACKGROUND: A diagnostic scoring system such as the modified Alvarado score, combined with selective laparoscopy in adult females, can be used in the assessment of acute abdominal pain suggestive of appendicitis. METHOD: A total of 84 consecutive patients presenting to our surgical team with suspected appendicitis were assessed prospectively using the modified Alvarado score. The definitive management of this study group was instigated according to a set algorithm based on the score. The algorithm included the use of diagnostic laparoscopy in adult female patients with scores suggestive of appendicitis. A negative appendicectomy rate was obtained from those undergoing appendicectomy using this approach and compared to that obtained from the 97 patients that had undergone appendicectomy under the care of the other surgical teams in our unit during the study period. RESULTS: The rate of negative appendicectomy in the study group was 0% compared to 18% in the control group (P < 0.05); 10% of adult female women had negative diagnostic laparoscopies for appendicitis thus saving this group an unnecessary appendicectomy. This was achieved without an increase in total in-patient stay. CONCLUSION: An algorithm combining the modified Alvarado score with selective laparoscopy is recommended for widespread use in the management of suspected acute appendicitis.
Asunto(s)
Apendicitis/diagnóstico , Laparoscopía , Enfermedad Aguda , Adulto , Algoritmos , Apendicectomía , Apendicitis/cirugía , Niño , Diagnóstico Diferencial , Femenino , Indicadores de Salud , Humanos , Masculino , Estudios Prospectivos , Procedimientos Innecesarios/estadística & datos numéricosRESUMEN
Small-bowel resection has been identified as a core surgical skill that all general surgical trainees must acquire. Most of these resections are performed by the unsupervised higher surgical trainee on call. Reviewing 51 small-bowel resections performed over a five-year period in a district general hospital we found that, although the operation carried a high mortality rate (18%) and a high morbidity rate (21%), these had less to do with the operative technique than with the nature of the underlying disease and the hazards of emergency surgery in general. We conclude that small-bowel resection per se is relatively safe and remains a good training procedure.