Association between the appendix and the fecalith in adults.

BACKGROUND: We sought to determine the association between the presence of a fecalith and acute/nonperforated appendicitis, gangrenous/perforated appendicitis and the healthy appendix. METHODS: We retrospectively analyzed appendectomies performed between October 2003 and February 2012. We collected data on age, sex, appendix histology and the presence of a fecalith. RESULTS: During the study period, 1357 appendectomies were performed. Fecaliths were present in 186 patients (13.7%). There were 94 male (50.5%) and 92 female patients, and the mean age was 32 (range of 10-76) years. The fecalith rate was 13%- 16% and was nonexistant after age 80 years. The main groups with fecaliths were those with acute/nonperforated appendicitis (n = 121, 65.1%, p = 0.041) and those with a healthy appendix (n = 65, 34.9%, p = 0.003). The presence of fecaliths in the gangrenous/perforated appendicitis group was not significant (n = 19, 10.2%, p = 0.93). There were no fecaliths in patients with serositis, carcinoid or carcinoma. CONCLUSION: Our data confirm the theory of a statistical association between the presence of a fecalith and acute (nonperforated) appendicitis in adults. There was also a significant association between the healthy appendix and asymptomatic fecaliths. There was no correlation between a gangrenous/perforated appendix and the presence of a fecalith. The fecalith is an incidental finding and not always the primary cause of acute (nonperforated) appendictis or gangrenous (perforated) appendicitis. Further research on the topic is recommended.

CONTEXTE: Nous avons voulu examiner le lien entre la présence d'un fécalome et l'appendicite aiguë/non perforée, l'appendicite gangreneuse/perforée et un appendice sain. MÉTHODES: Nous avons analysé de manière rétrospective les appendicectomies effectuées entre octobre 2003 et février 2012. Nous avons recueilli des données sur l'âge, le sexe, l'histologie de l'appendice et la présence d'un fécalome. RÉSULTANTS: Durant la période de l'étude, 1357 appendicectomies ont été effectuées. Des fécalomes étaient présents chez 186 patients (13,7 %). L'étude regroupait 94 hommes (50,5 %) et 92 femmes; l'âge moyen était de 32 ans (entre 10 et 76 ans). Le taux de fécalome était de 13 % à 16 % et non existant après l'âge de 80 ans. Les principaux groupes porteurs de fécalomes étaient ceux qui présentaient une appendicite aiguë/non perforée (n = 121, 65,1 %, p = 0,041) et ceux dont l'appendice était sain (n = 65, 34,9 %, p = 0,003). La présence de fécalomes dans le groupe souffrant d'appendicite gangreneuse/perforée s'est révélée non significative (n = 19, 10,2 %, p = 0,93). Les patients qui souffraient de sérosite, de carcinoïde ou de carcinome ne présentaient pas de fécalomes. CONCLUSION: Nos données confirment la théorie d'un lien statistique entre la présence d'un fécalome et une appendicite aiguë (non perforée) chez l'adulte. On a également observé un lien significatif entre un appendice sain et des fécalomes asymptomatiques. On n'a observé aucune corrélation entre un appendice gangreneux/perforé et la présence de fécalomes. Le fécalome est une observation accessoire qui n'est pas toujours la principale cause de l'appendicite aiguë (non perforée) ou de l'appendicite gangreneuse (perforée). Une recherche plus approfondie à ce sujet est recommandée.

Case series: The modified skoog approach for definitive management of severe hidradenitis suppurativa of the axilla.

Hidradenitis Suppurativa (HS) is a chronic, recurrent, suppurative, cutaneous disease, manifested by abscesses, fistulating sinus tracts and scarring (Brown, Rosen, & Orengo, 1998). After failed conservative management, surgical excision is the only definitive option (Edlich et al. 1986). There are several approaches to the excision and wound closure of axillary HS, mostly involving radical excision with associated risks of poor wound healing despite advanced wound closure techniques. We present a case series using the Modified Skoog approach for the management of axillary HS as a skin sparing technique that offers adequate wound healing, a short hospital stay and high patient satisfaction.

An 8-YEAR analysis of bone tumours in a Caribbean island.

BACKGROUND: An epidemiologic analysis of bone tumours in Trinidad & Tobago. METHODS: A retrospective analysis of primary and secondary bone tumours, site of origin and demographic data was conducted. RESULTS: 63 bone tumours were analysed and included 27 primary benign (43%), 12 primary malignant (19%), 19 metastatic (30%) and 5 by contiguous spread (8%). The most common malignant primary tumour was the osteosarcoma (n = 7), originating from the femur in mostly males in the 11-20 age group. There was 1 chondrosarcoma, 2 fibrosarcomas and 2 plasmacytomas. Benign tumours consisted of 8 osteochondromas, 2 osteomas, 3 giant cell tumours, 3 bone cysts and 11 cases of fibrous dysplasia. CONCLUSION: Bone tumours are rare with a low incidence of 1.125 per 100,000 population annually and malignant tumours being even rarer at an incidence of 0.18 per 100,000 population annually. There is need for better documentation and data registries in Trinidad and Tobago.

Incidence of tongue carcinoma in Trinidad and Tobago, West Indies.

The incidence of tongue carcinoma in Trinidad and Tobago and the greater West Indies is unknown; therefore, the present study examines the frequency of tongue carcinoma cases, drawing comparisons to worldwide and regional data. A retrospective analysis of all confirmed cases of tongue carcinoma was conducted using eight years of data from the pathology records at the Port of Spain General Hospital (Port of Spain, Trinidad and Tobago). A total of 26 cases were confirmed, of which 21 were male (81%) and five were female (19%). The age range was 29-86 years, with a mean age of 57 years, and the most common group affected was the 61-70 years age group. In addition, the number of newly diagnosed cases per year ranged between one and seven, with an average of 3.25 new cases per year and a peak incidence of seven new cases in the year of 2009. In the 19 cases where the degree of differentiation was recorded, histological analysis revealed the extent of differentiation as follows: Five cases (26%) were poorly-differentiated squamous cell carcinoma (SCC); eight cases (42%) were moderately-differentiated SCC; and six cases (32%) were well-differentiated SCC. In addition, one case of chronic inflammatory process and one case of mucoepidermoid adenocarcinoma of the tongue in a 57-year-old female were identified. Overall, the incidence of tongue carcinoma in Trinidad and Tobago appears to be low, estimated at 0.46/100,000 individuals/year. The male:female ratio is 4:1 and SCC is the dominant cancer type (96% of cases). The peak age of occurrence is at 61-70 years. These findings are in agreement with previously determined global data, however, additional research of the risk factors and outcomes of surgery as a treatment strategy for tongue carcinoma is required.

Parotid gland tumours in a West Indian population: Comparison to world trends.

The epidemiology of parotid gland tumours in Trinidad and Tobago and the wider Caribbean is currently unknown. Therefore, an analysis of the pathological records was conducted to determine the pattern of this disease in Trinidad and Tobago. A retrospective analysis was conducted on all parotid gland tumours and the demographic and histological data were analysed. Data from 60 cases were collected over a period of 8 years (October, 2003 to February, 2012), including 56 primary and 4 secondary tumours (1 basal cell carcinoma and 3 metastatic tumours). The patients included 31 men and 29 women, with a mean age of 48.7 years and an age range of 21-73 years (peak age, 51-60 years). The surgical interventions included 53 superficial parotidectomies, 6 radical parotidectomies and 1 biopsy. Of the 56 primary tumours, 41 were benign [34 pleomorphic adenomas and 7 Warthin's tumours (adenolymphomas)], accounting for 73.2% of the cases. The malignant lesions included 6 squamous cell carcinomas, 3 mucoepidermoid carcinomas, 2 acinic cell carcinomas, 2 adenoid cystic carcinomas, 1 anaplastic carcinoma and 1 papillary carcinoma, accounting for 26.8% of the total cases, without any age predominance. The pattern of disease distribution was similar to that indicated by worldwide data, with benign primary lesions accounting for ~80% of the cases (pleomorphic adenomas, 80% and Warthin's tumours, 20%). The most common carcinomas were mucoepidermoid and adenoid cystic types, as indicated by worldwide data; however, in our series, squamous cell carcinoma was the most common type, followed by mucoepidermoid, acinic cell and adenoid cystic carcinomas. The present study will hopefully provide useful information on parotid pathology in Trinidad and Tobago and encourage further research in this field.