Critical role of hyperthermic intraperitoneal chemoperfusion in the treatment of a patient with Pseudomyxoma peritonei.

The role of hyperthermic intraperitoneal chemoperfusion (HIPEC) in the treatment of Pseudomyxoma peritonei is debated by clinicians. We report the case of a patient who had multiple episodes of short-interval disease recurrence following debulking surgery, and only achieved long-term remission with the addition of HIPEC. A review of the relevant literature is presented.

Retrohepatic hematoma causing caval compression after blunt abdominal trauma.

Blunt injury to the inferior vena cava (IVC) is a rare event, which occurs in 1% to 10% of blunt-trauma patients. Injuries usually result from deceleration, which causes atriocaval rupture or tearing of the hepatic veins, and are sometimes complicated by uncontrollable hemorrhage. An unusual case of focal extrinsic compression of the vessel caused by retrohepatic hemorrhage is reported, which ultimately has required no operative intervention and seems to have had no long-term ill effects. The literature on blunt injury to the IVC is reviewed, which includes a review of posttraumatic Budd-Chiari syndrome.

Increasing the number of attacks increases the conversion rate in laparoscopic diverticulitis surgery.

BACKGROUND: This study aimed to determine whether the number of diverticulitis or complicated diverticulitis episodes affects the conversion rate or postoperative complication rate in elective laparoscopic sigmoid colectomy. METHODS: In this study, 216 charts were reviewed for baseline characteristics, diverticulitis history, and intra- and postoperative complications. Analysis was performed with the Student's t-test, the chi-square test, and Fisher's exact tests. RESULTS: Of 216 sigmoid colectomies, 151 were laparoscopic, 19 were converted, and 46 were open. Baseline characteristics were similar for patients with zero to two and those with three or more inpatient diverticulitis attacks. Patients with uncomplicated diverticulitis had a higher rate of conversion after three or more inpatient episodes (2.6% vs 25%; p = 0.04). There was no difference in operative times or postoperative complication rates. Patients with a history of abscess had a 23% chance of conversion. Those with no abscess history had an 8% chance of conversion (p = 0.02). In general, converted procedures required more time than open procedures but were associated with decreased hospital length of stay (LOS) and a decreased rate of postoperative ileus. CONCLUSION: Multiple inpatient diverticulitis attacks and a history of abscess were associated with laparoscopic conversion. Converted procedures required more time than open procedures, but had reduced LOS and postoperative ileus. Laparoscopic sigmoid colectomy can be attempted safely for patients with three or more inpatient attacks or a history of complicated diverticulitis.

Do men and women use the same criteria in selecting a general surgery residency program? Results of a 20-year study in a non-university program.

BACKGROUND: To assess applicant preferences in general surgery program selection, we surveyed current and former residents of our non-university general surgery residency program over the last 20 years, with particular emphasis on male and female selection preferences. METHODS: Surveys were distributed to current and former categorical residents. Respondents were asked to rate 25 residency criteria using a Likert scale. Responses by males and females were compared using the Mann-Whitney U-test. Results are reported as mean scores, with p-values indicating statistical significance of trends toward higher scores. RESULTS: Of 50 former (76% male, 24% female) and 18 current residents (56% male, 44% female), 56 responded (38 male, 18 female), for an overall response rate of 82%. For both male and female respondents, the top 4 selection criteria by mean average score were identical: variety and number of cases, friendly training environment, camaraderie among residents, and quality of relationships with attendings. Selection criteria that received significantly higher scores among women were camaraderie among residents, the number of female residents, and the number of female attendings (p < 0.05). For men, a suburban location, compensation and benefits, and the reputation of the program director received significantly higher scores (p < 0.05). Gender-related selection preference was most marked for the number of female residents (mean, 2.4 for women vs 1.3 for men) and the number of female attendings (mean, 2.3 for women vs 1.4 for men). These 2 criteria, however, were ranked 20th and 21st (of the 25), respectively, by the female respondents. CONCLUSIONS: The most important selection criteria, regardless of gender, relate to operative experience, training environment, and quality relationships. Gender-based preferences seem to play only a minor role in general surgery program selection.

Characteristics and treatment of metaplastic breast cancer: analysis of 892 cases from the National Cancer Data Base.

BACKGROUND: Metaplastic breast cancer (MBC) is characterized by various combinations of adenocarcinoma, mesenchymal, and other epithelial components. It was officially recognized as a distinct pathologic diagnosis in 2000. With few published reports, we hypothesized that MBC may have markedly different characteristics at presentation than typical infiltrating ductal carcinoma (IDC) and may be managed differently. METHODS: Data from patients with MBC and IDC reported to the National Cancer Database from January 2001 through December 2003 were reviewed for year of diagnosis, patient age, race/ethnicity, tumor size, nodal status, American Joint Committee on Cancer (AJCC) stage, tumor grade, hormone receptor status, and initial treatment, and were analyzed statistically by the Pearson chi(2) test. RESULTS: A total of 892 patients with MBC and 255,164 patients with IDC were identified. The group with MBC was older (mean age, 61.1 vs. 59.7 years; P = .001), had a significantly increased proportion of African American (14.1%, 126 of 892, vs. 10.2%, 25,900 of 255,164; odds ratio [OR], 1.455, P = .001) and Hispanic patients (5.5%, 49 of 892 vs. 3.9%, 9,947 of 255,164; OR, 1.817, P = .001), had fewer T1 tumors (29.5% vs. 65.2%), more N0 tumors (78.1% vs. 65.7%, OR, .5, P = .001), more poorly or undifferentiated tumors (67.8% vs. 38.8%), and fewer estrogen receptor-positive tumors (11.3% vs. 74.1%, OR, 22.4, P = .001) than the IDC group. Patients with MBC were treated with breast-conserving surgery less frequently than patients with IDC (38.5% vs. 55.8%, OR, 2.0, P = .001) because of the larger tumor size. Chemotherapy was used more often for patients with MBC (53.4% vs. 42.1%, OR, 1.6, P = .001) because of more advanced AJCC stage. CONCLUSIONS: MBC is a rare tumor with different characteristics than IDC: it presents with larger tumor size, less nodal involvement, higher tumor grade, and hormone receptor negativity. Patients with MBC are treated more aggressively than IDC (more often with mastectomy and chemotherapy) because of a higher stage at presentation, but are being treated by the same principles as IDC. Follow-up will determine the long-term results of the current treatment.