A clinical oncologic perspective on breast magnetic resonance imaging.

Magnetic resonance (MR) imaging identifies cancer not found by clinical examination or other breast imaging studies, but its effect on patient outcomes is controversial. To date, its use has not been shown to increase the likelihood of obtaining negative surgical margins, decrease the rate of conversion from lumpectomy to mastectomy, or decrease local recurrence. The rate of tumor identification with MR imaging is 2 to 3 times higher than the incidence of local recurrence, resulting in mastectomies that may not be beneficial to the patient. This is also a concern with the use of MR imaging for contralateral cancer detection. The use of MR imaging for early detection of local recurrence does not take into account what is known about the biology of local recurrence because a short interval to local recurrence is associated with poor prognosis. In problem areas, such as evaluation of response to neoadjuvant therapy and detection of cancer presenting as axillary adenopathy, MR imaging provides information that is useful for clinical management.

Laparoscopic drainage of postappendectomy- retained fecalith and intra-abdominal abscess in the pediatric population.

Retained fecalith after an appendectomy is an uncommon complication frequently associated with intra-abdominal abscess. Treatment options include percutaneous, open, or laparoscopic drainage of the abscess and retrieval of the fecalith, as antibiotics and drainage alone are usually insufficient. Laparoscopy offers the advantages of enhanced visualization of the abdomen, improved cosmesis, and a quicker return to normal daily activities. The principles of laparoscopic treatment include the careful identification of all anatomic landmarks, as the abscesses are frequently adherent to intra-abdominal structures compromising the safety of the operation. In this paper, we present 2 cases of laparoscopic drainage of an intra-abdominal abscess with retrieval of a fecalith in pediatric patients 1 and 6 weeks after an initial appendectomy and a review the literature.

Gestational macromastia: a medical and surgical challenge.

Gestational macromastia is a rare and complex disorder. Establishing an optimal medical and surgical management regimen has been challenging. Medical regimens have included tamoxifen, progesterone, bromocriptine, and testosterone. Surgical therapies have included reduction mammaplasty and mastectomy. This report will highlight the successful medical and surgical management in a woman with severe gestational macromastia.