Is Surgery Safe in Gallstone-Related Acute Diseases in Elderly Patients?

OBJECTIVE: To determinate the safety of the surgical treatment of acute biliary pancreatitis and acute cholecystitis in elderly patients. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey, from January 2010 to July 2012. METHODOLOGY: Records of 172 patients with acute complications of biliary calculi, aged over 65 years, were included. Patients were assessed for demographic information, hospitalisation diagnosis, leucocyte count, ASA classification, treatment type, conversion rates, length of hospital stay, morbidity and mortality. Statiscal analyses were performed using the SPSS version 20.0. RESULTS: The sample included 128 females (74.4%) and 44 males (25.6%). Patients' diagnoses included 135 (78.4%) acute cholecystitis and 37 (21.6%) acute pancreatitis. Medical treatment was offered to 113 patients (65.7%). Open cholecystectomy was directly performed in 17 patients (9.9%). Two patients (4.8%) were converted to an open cholecystectomy during surgery, while a laparoscopic cholecystectomy was performed sucessfully on 42 patients (24.4%). Those who underwent surgery were discharged as cured, except for minimal surgical complications. CONCLUSION: Treatment choice in acute gallstone complications in the elderly depends on the patient's general condition, severity of the disease, and ASAscore. Early laparoscopic cholecystectomy is a good option in selected elderly patients with acute cholecystitis and non-severe acute biliary pancreatitis.

A Rare Clinical Entity in the Differential Diagnosis of Mastalgia: Thoracic Zona.

OBJECTIVE: Mastalgia is the most common complaint of patients who are admitted for breast examination. Breast pain may originate breast tissue pathologies or non-breast pathologies adjacent organs. One of the causes of mastalgia is the varicella-zoster infection of the thoracic nerve ganglions. The zona zoster infection is painful, and vesicular lesions in the infected dermatomal regions can be observed because of the reactivation of the latent varicella (Herpes)-zoster virus (VZV) in the dorsal radix of medulla spinalis. There are no reviews of the zona cases of mastalgia patients in the literature. We aimed to investigate and represent the characteristics of these patients. MATERIALS AND METHODS: Patients complaining of mastalgia and who were diagnosed with zona zoster infection after physical examination and clinical evaluation in the outpatients department of General Surgery were investigated retrospectively between January 2010 and January 2015. RESULTS: The study included 12 patients. All of them were female, and the mean age of patients was 51.66 (36-72) years. Eight of the zona cases were seen in the right breast (66.6%), and four of them were seen in the left breast (33.4%). Complaints of patients were pain (100%), eruption (70%), and burning sensation (60%). Underlying pathology was seen in one of the cases. Physical examination at admission revealed that four of the patients did not have any physical abnormality (33.3%). On the contrary of vesicular lesions, typical physical findings of zona, were seen in eight patients (66.7%). CONCLUSION: Detailed history analysis and physical examination of the breast should be performed, particularly in older patients with unilateral severe mastalgia, and zona should be considered.

Spontaneous rupture of tubal leiomyoma causing haemoperitoneum.

Leiomyomas are benign tumours that usually originate from the genital tract organs, particularly from the uterus. Spontaneous rupture of leiomyomas is a relatively rare condition. Herein, we report a 70 years old lady who was admitted through the emergency room with sudden abdominal pain. A ruptured mass originating from the fallopian tube, causing haemoperitoneum was revealed at laparotomy. Pathological examination revealed cellular leiomyoma.